Pericardial Disease and Pericarditis
Pericarditis is an inflammation of the pericardium, the membrane forming the outer covering of the heart. The inflammation causes a thickening and roughening of the membrane and an accumulation of fluid in the sac surrounding the heart.
Causes of Pericarditis
Most pericarditis in this country is caused by a viral infection. The disease also may be caused by bacteria, fungi, or parasites. In the past and among people from certain parts of the world, TB is a common cause of pericarditis. There is also a noninfectious pericarditis; causes include disease of the underlying heart muscle, injury, and other diseases, such as rheumatoid arthritis, lupus erythematosus, or kidney failure. Cancer radiation therapy to the chest also can cause pericarditis.
Most mild to moderate pericarditis goes undetected from lack of symptoms. In the more severe cases, the most common symptom is pain or discomfort on the anterior chest, which may extend to the left side of the chest and to the left shoulder. The pain often becomes worse with a deep breath and is relieved when sitting or leaning forward. When the doctor listens to the heart and chest with a stethoscope, a grating sound can be heard, caused by a rubbing of the roughed pericardium surfaces with each heartbeat.
Pericarditis can be a difficult diagnosis to make. Electrocardiogram, chest x-ray, and echocardiogram may be normal. Additional tests, such as blood cultures, skin tests, or tests on the fluid in the sac surrounding the heart, may help determine the cause of pericarditis.
Treatment includes antibiotic therapy directed at the invading microorganism. Analgesics and anti-inflammatory drugs may be prescribed to relieve pain and inflammation. In most cases, especially those caused by a virus, the disease is selflimiting, requiring no further treatment.
Complications of Pericarditis
Early detection and treatment are important to prevent potentially serious complications. For example, untreated bacterial or chronic pericarditis may cause the pericardium to lose its elasticity, causing a constriction of the heart. If the heart is unable to function normally because of pericardial constriction, surgery to remove part of the pericardium may be required. Another potentially serious complication of pericarditis, especially that caused by a bacterial infection, injury, or tumor, is cardiac tamponade, which is caused by an accumulation of fluid in the pericardial sac, resulting in excessive pressure on the heart. If untreated, blood pressure will drop along with cardiac output. This is an emergency situation that is treated by puncturing the pericardial sac to remove the fluid.
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