Overview
Pericarditis is swelling and irritation of the pericardium, the thin sac-like membrane surrounding your heart. Pericarditis often causes chest pain and sometimes other symptoms. The sharp chest pain associated with pericarditis occurs when the irritated layers of the pericardium rub against each other.
Pericarditis usually begins suddenly but doesn't last long (acute). When symptoms persist, it is considered as chronic.
Most cases are mild and usually improve on their own. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help to reduce the risk of long-term complications from pericarditis.
Symptoms
Acute pericarditis usually lasts less than a few weeks. While the Chronic recurrent pericarditis has two types, including the incessant type which occurs within six weeks of medical treatment for an acute episode, and the intermittent type which occurs after six weeks.
If you have acute pericarditis, the most common symptom is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. However, some people with acute pericarditis describe their chest pain as dull, achy or pressure-like instead, and of varying intensity.
The pain of acute pericarditis may travel into your left shoulder and neck. It often intensifies when you cough, lie down or inhale deeply. Sitting and leaning forward can often ease the pain. At times, it may be difficult to distinguish pericardial pain from the pain that occurs with a heart attack.
Chronic pericarditis is usually associated with chronic inflammation. Its most common symptom of is chest pain.
Depending on the type, signs and symptoms of pericarditis may include some or all of the following:
- Sharp, piercing chest pain over the center or left side of the chest.
- Shortness of breath when reclining.
- Heart palpitations.
- Low-grade fever.
- An overall sense of weakness, fatigue.
- Cough.
- Abdominal or leg swelling.
Seek immediate medical care if you develop new symptoms of chest pain.
Many of the symptoms of pericarditis are similar to those of other heart and lung conditions. The sooner you are evaluated, the sooner you can receive proper diagnosis and treatment. For example, although the cause of acute chest pain may be pericarditis, the original cause could have been a heart attack or a blood clot of the lungs (pulmonary embolus).
Possible Cause
Under normal circumstances, the two-layered pericardial sac that surrounds your heart contains a small amount of lubricating fluid. In pericarditis, the sac becomes inflamed and the resulting in heartache from friction.
The cause of pericarditis is often hard to determine. In most cases, doctors either are unable to determine a cause (idiopathic) or suspect a viral infection. It can also develop shortly after a major heart attack, due to the irritation of the underlying damaged heart muscle. In addition, a delayed form of pericarditis may occur weeks after a heart attack or heart surgery. This delayed pericarditis is known as Dressler's syndrome. Many experts believe Dressler's syndrome is due to a mistaken inflammatory response by the body to its own tissues (autoimmune response) — in this case, the heart and pericardium.
Other causes may be:
- Systemic inflammatory disorders. These may include lupus and rheumatoid arthritis.
- Trauma. Injury to your heart or chest may occur as a result of a motor vehicle or other accident.
- Other health disorders. These may include kidney failure, AIDS, tuberculosis and cancer.
- Certain medications. Some medications can cause pericarditis, although this is unusual.
Complications
Complications may include:
- Constrictive pericarditis Although uncommon, some people with pericarditis, particularly those with long-term inflammation and chronic recurrences, can develop permanent thickening, scarring and contraction of the pericardium.
In these people, the pericardium loses much of its elasticity and resembles a rigid case that's tight around the heart, which keeps the heart from working properly. This condition is called constrictive pericarditis and often leads to severe swelling of the legs and abdomen, as well as shortness of breath.
- Cardiac tamponade When too much fluid collects in the pericardium, a dangerous condition called cardiac tamponade can develop.
Excess fluid puts pressure on the heart and doesn't allow it to fill properly. That means less blood leaves the heart, which causes a dramatic drop in blood pressure.
- Cardiac tamponade can be fatal if it isn't promptly treated Early diagnosis and treatment of pericarditis usually reduces the risk of the long-term complications.
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