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Pericardial Disease

Pericarditis is inflammation of the pericardium, the membrane that surrounds and protects the heart. It occurs in two forms: acute (sudden and short-lived) and chronic (persistent over long periods).

The most common type of acute pericarditis, caused by a viral infection, generally resolves spontaneously with no permanent damage, even without treatment. Acute pericarditis due to bacterial infection, however, may cause fluid to accumulate in the space between the pericardium and the heart (pericardial effusion) and interfere with the heart’s ability to function properly. This may result in severe symptoms and may even be fatal unless fluid is promptly removed from the pericardial sac.

In chronic pericarditis, ongoing inflammation scars and thickens the pericardium (constrictive pericarditis) so that it constricts the heart and hinders the heart’s ability to fill with blood returning from the great veins. Constrictive pericarditis nearly always leads to progressive heart failure; surgical intervention is often favorable.

When to Call an Ambulance
Symptoms
Causes
Prevention
Diagnosis
Treatment

When to Call an Ambulance 
If you experience any of the symptoms described below, get to a doctor as soon as possible.

Symptoms
The following provides an overview of the symptoms of pericarditis:

  • Acute pericarditis: severe, sudden chest pain (different from angina) that may spread to the neck, back, shoulders or arms, and is often worse when breathing deeply or changing position and relieved by sitting up or leaning forward; fever.
  • Pericardial effusion: breathing difficulty or ill-defined pain or fullness in the chest.
  • Chronic pericarditis: swelling in the legs and abdomen due to fluid retention, breathing difficulty, fatigue.

In some cases, no symptoms may occur.

Causes
Acute pericarditis may result from a number of underlying disorders, including viral, bacterial or fungal infection; heart attack; rheumatic fever; systemic lupus erythematosus; rheumatoid arthritis; hypothyroidism; metastatic cancer; and kidney failure. Acute pericarditis may also occur following a chest injury or open heart surgery.

Chronic pericarditis may develop from recurrent acute cases or may result from a chronic infection such as tuberculosis.

In some cases the cause of pericarditis is unknown.

Prevention
There are no specific measures to prevent this condition.

Diagnosis
The Johns Hopkins Cardiomyopathy and Heart Failure Practice, directed by Dr. Joshua Hare, manages patients with pericarditis and heart failure due to any cause. Using a multidisciplinary approach that includes social work, dietary counseling, physical rehabilitation, educational programs and support groups, our goal is to empower patients to better care for themselves. Our physicians believe that transplantation is the “court of last resort” and will do everything possible to avoid transplantation.

To be evaluated for pericarditis, one of our physicians will first examine you at our Outpatient Center or satellite facility at Green Spring Station. If necessary, we may ask you to undergo one or more of the following tests. Most are performed at the outpatient locations. Fluid cultures and imaging tests are done in the hospital’s Cardiovascular Diagnostic Laboratory and cardiac MRI unit.

  • Your doctor may take blood and urine samples to assess the level of infection.
  • Your doctor may order chest X-rays to look for inflammation.
  • You may undergo an electrocardiogram, also called an ECG or EKG, which records your heart’s electrical activity during rest to determine abnormal heart rhythms.
  • Your doctor may order an echocardiogram to evaluate heart function. During this test, sound waves bounced off the heart are recorded and translated into images. The pictures can reveal abnormal heart size, shape and movement. Echocardiography also can be used to calculate the ejection fraction, or volume of blood pumped out to the body when the heart contracts.
  • The doctor may take a sample of the fluid surrounding the heart, to identify infectious organisms. In this test, a small needle is inserted between into the chest between the ribs into the pericardium, the thin sac that surrounds the heart, and a small amount of fluid is withdrawn. Samples of the fluid are placed in various laboratory cultures, which are observed for the growth of bacteria.
  • Other diagnostic tests, such as a computed tomography (CT) scan or magnetic resonance image (MRI), can also be used.

Treatment
Medications such as antibiotics to treat bacterial infections or diuretics to reduce fluid retention may be prescribed if your doctor can identify an underlying cause to the condition. Over-the-counter pain medicines, including aspirin and ibuprofen, can reduce pain and inflammation. You may also be advised to restrict physical activity or be on bed rest for a period of time.

There are also procedures that can help relieve pressure on the heart. Your doctor may drain the excess fluid around your heart in a procedure known as pericardiocentesis. More advanced cases may require surgery to remove part or all of the pericardium, the thin sac that surrounds the heart. This procedure, called pericardectomy, is the treatment of choice for chronic pericarditis and often yields excellent results.


 

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