What is Pericarditis?
The pericardium is the fibroserous sac that envelops, supports, and protects the heart. Inflammation of this sac is called pericarditis.
This condition occurs in acute and chronic forms.The acute form can be fibrinous or effusive, with serous, purulent, or hemorrhagic exudate. The chronic form (called constrictive pericarditis) is characterized by dense fibrous pericardial thickening.The prognosis depends on the underlying cause but typically is good in acute pericarditis unless constriction occurs.
Causes of Pericarditis
Common causes of this disorder include:
Less common causes of pericarditis include aortic aneurysm with pericardialleakage and myxedema with cholesterol deposits in the pericardium.
Signs & Symptoms of Pericarditis
The most common symptom of pericarditis is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. But a minority of people with this condition describe their chest pain as dull, achy or pressure-like instead, and of varying intensity. The sharp pain may travel into your left shoulder and neck. It often intensifies when you lie down or inhale deeply. Sitting up 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.
Chest X-ray - With an X-ray of your chest, your doctor can study the size and shape of your heart. Images of your heart may show an enlarged heart if excess fluid has accumulated in the pericardium.
Electrocardiography shows characteristic changes in acute pericarditis. They include elevated ST segments in the limb leads and most precordial leads. The QRS segments may be diminished when pericardial effusion is present. Rhythm changes may also occur, including atrial ectopic rhythms (such as atrial fibrillation) or sinus arrhythmias.
Echocardiography indicates pericardial effusion when it shows an echo-free space between the ventricular wall and the pericardium.
Computerized tomography (CT). This X-ray technique can produce more-detailed images of your heart and the pericardium than would conventional X-ray studies.
Appropriate treatment aims to relieve symptoms, manage underlying systemic disease, and prevent or treat pericardial effusion and cardiac tamponade.
In idiopathic pericarditis, postmyocardial infarction pericarditis, and postthoracotomy pericarditis, treatment consists of bed rest as long as fever and pain persist and the administration of nonsteroidal drugs, such as aspirin and indomethacin, to relieve pain and reduce inflammation. If symptoms continue, the doctor may prescribe corticosteroids. Although they provide rapid and effective relief, corticosteroids must be used cautiously because the disorder may recur when drug therapy stops.
When infectious pericarditis results from disease of the left pleural space, mediastinal abscesses, or septicemia, the patient requires either antibiotics, surgical drainage, or both. If cardiac tamponade develops, the doctor may perform emergency pericardiocentesis and may inject antibiotics directly into the pericardial sac.
Recurrent pericarditis may require partial pericardectomy, which creates a window that allows fluid to drain into the pleural space. In constrictive pericarditis, total pericardectomy may be necessary to permit the heart to fill and contract adequately. Treatment must also include management of rheumatic fever. uremia, tuberculosis, and other underlying disorders.
Many cases may not be preventable. Treat respiratory infections and other disorders promptly.
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