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Pericarditis

Pericarditis is the inflammation of the of the pericardium, the membrane enclosing the heart and the large blood vessels connected to the heart, consisting of outer and inner layers. In between the two layers is a small amount (15-50 milliliters) of clear, yellow fluid that reduces friction and allows the heart to beat more easily.

Causes/Risk Factors
  • Viral or bacterial pericarditis is caused by infection.
  • Pericarditis not caused by infection may occur due to heart attack, injury to the heart, rupture of the arteries near the heart, cancer in the chest, radiation to the chest, etc.
  • Pericarditis due to compromised immunity, such as due to systemic lupus erythematous (SLE), rheumatic fever, rheumatoid arthritis, etc.
  • Sharp pain or tightness in the middle of the chest or on the left that may radiate to the neck, shoulders, and the left shoulder blade; symptoms may worsen when you inhale or lie flat and ease when you bend forward.
  • Fever, fatigue/weakness, difficulty or rapid breathing, cough, heart palpitations.
  • Chronic pericarditis may not present with any symptoms until the condition is severe, causing abdominal swelling, leg swelling, and low blood pressure.
  • History of cold or respiratory infection
  • History of heart attack or injury to the chest
  • Other medical history
The doctor will listen to the sounds of your heart, which is caused by the friction between the two layers of the pericardium and is related to the movement of the heart. These sounds occur in the early stages of the disease when there is not much liquid between the two layers. The sounds can be heard using a stethoscope. The sounds may come and go and if it’s not heard one day, it may be heard the next day.
  • Electrocardiogram (EKG) that shows the heart’s electrical activity can reveal pericarditis.
  • Chest x-ray: the heart’s shadow and enlarged vessels can be seen on x-ray if there is a fluid in the pericardium.
  • Ultrasound can reveal fluid in the pericardium.
  • Computed tomography (CT) scan and magnetic resonance imaging (MRI) are best for accurately detecting disease.
  • Blood tests can differentiate all the causes of pericarditis and help determine if it is caused by heart attack of infection.
  • Treatment is aimed at reducing chest pain, inflammation of the heart, and the cause of the disease.
  • The doctor may focus on alleviating pain and inflammation to start and recommend resting at home.
  • If the condition is caused by infection, the doctor may admit the patient for antibiotics. If there is a lot of fluid compressing the heart, that fluid will need to be drained with a needle and a small tube.
  • If the disease is chronic and the pericardium has thickened into adhesions and there is plaque collected that can affect the heart’s function, especially when the heart contracts, surgery may be the best option to allow the heart to beat normally.
Pericarditis is usually related to excessive fluid around the heart and this can put pressure on the heart, preventing it from filling properly. Less blood leaves the heart, leading to low blood pressure and ultimately shock. This is an emergency situation and requires immediate treatment.
 
Acute pericarditis cannot be prevented, but can be resolved with immediate treatment and carefully following your doctor’s instructions, which also prevent complications and chronic inflammation.

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