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Pericarditis
Pericarditis refers to inflammation of the pericardium, the bag-like sac that encloses the heart. There are a number of conditions that can lead to pericarditis.
CAUSES OF PERICARDITIS
1. UNKNOWN CAUSES
2. VIRAL INFECTIONS (Coxsackievirus and Echo virus)
3. CANCER (lymphoma and leukemia)
4. DRUG INDUCED (procainamide and others)
5. SYSTEMIC LUPUS ERYTHEMATOSUS
6. RADIATION INDUCED (in patients receiving radiation therapy for various forms of cancer)
7. KIDNEY FAILURE
8. BACTERIAL INFECTIONS (e.g. tuberculosis, mycoplasma)
Common symptoms include chest pain that is "sharp" and frequently made worse when lying flat, or breathing deeply. Relief commonly occurs when the patient leans forward. Pericarditis is often caused by a viral infection. In this case, it may be preceded by symptoms consistent with an upper respiratory infection (i.e. cough, runny nose, sore throat). Evaluation of this condition will involve history for potential exposures and physical examination. EKG can reveal characteristic changes consistent with pericarditis. Chest x-ray and blood tests (i.e. CBC and kidney profile) will be performed. Viral cultures (blood) may be obtained to identify the virus. Echocardiogram can show abnormal thickening of the pericardium, or if an abnormal collection of fluid has accumulated around the heart (pericardial effusion). Pericarditis can also lead to inflammation of the heart muscle (myocarditis). Myocarditis, when it complicates pericarditis, can result in ineffective pumping of the heart. Severe scarring of the pericardial sac can result in constrictive pericarditis. In this case, the heart cannot adequately function due to the constrictive effects of the pericardial sac. Severe pericarditis can also result in an accumulation of fluid in the space between the pericardial sac and the heart. This condition, known as a pericardial effusion, can accumulate to the extent that heart muscle pump function is compromised. This clinical syndrome is known as pericardial tamponade. Treatment is specific to the underlying cause. Viral pericarditis, in most cases, is a self limited, nonserious illness that will improve with bedrest, avoidance of alcohol, certain medications, and over exertion. Close medical follow-up is important. Anti-inflammatories (ibuprofen) can help reduce pain. Any development of shortness of breath or palpitations could indicate a more serious heart complication (myocarditis) requiring hospitalization. See your doctor for evaluation of this important problem. The Cardiologist or Internist are the experts in the management of this problem.
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