Pericarditis is an inflammation of the pericardium.

Definition

Pericarditis is an inflammation of the pericardium. Pericarditis is usually acute it develops suddenly and may last up to several months.

The condition usually clears up after 3 months, but sometimes attacks can come and go for years.

When you have pericarditis, the membrane around your heart is red and swollen, like the skin around a cut that becomes inflamed. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion. Pericarditis can affect anyone, but it is most common in men aged 16 to 65.

Types

There are several types of pericarditis, and each one of them is identified by different symptoms.

Acute pericarditis: This type of pericarditis starts suddenly, but patients are likely to observe pain and other signs for two to three weeks. However, the possibility of it occurring again is likely. It can be difficult to evaluate the difference between the pain because of a heart attack and acute pericarditis.

Recurrent pericarditis: After you have faced an episode of acute pericarditis, there is a possibility of recurrent pericarditis. It occurs about four to six weeks after you have suffered from acute pericarditis, and you are likely to observe any symptoms in between the time frame.

Incessant pericarditis: This type lasts from four to six weeks and does not  last more than three months. You can observe continuous symptoms like chest pain.

Chronic constrictive pericarditis: This is a type as it develops slowly and has a longer duration than incessant pericarditis, like more than three months.

Causes

Causes of acute pericarditis include

Infection (viral, bacterial, parasitic, or fungal and, in people with AIDS, tuberculosis, or aspergillosis)

Heart attack

Heart surgery (postpericardiotomy syndrome)

Systemic lupus erythematosus (lupus)

Rheumatoid arthritis

Kidney failure

Chest injury

Cancer (such as leukemia, breast cancer, or lung cancer, or, in people with AIDS or Kaposi sarcoma)

Rheumatic fever

Radiation therapy

Drugs, including warfarin and heparin (anticoagulants), penicillin, procainamide (a drug used to treat abnormal heart rhythms), and phenytoin (an antiseizure drug)

Unknown (idiopathic or nonspecific pericarditis)

In people who have AIDS, a number of infections, including tuberculosis and aspergillosis, may result in pericarditis. Pericarditis due to tuberculosis (tuberculous pericarditis) accounts for less than 5% of cases of acute pericarditis in the United States but accounts for the majority of cases in some areas of India and Africa.

After a heart attack, acute pericarditis develops during the first day or two in 10 to 15% of people and after about 10 days to 2 months in 1 to 3% (subacute pericarditis). Subacute pericarditis is caused by the same disorders that cause acute pericarditis.

Symptoms

The following are the most common symptoms of pericarditis. However, each child may experience symptoms differently. Symptoms may include chest pain that:

Can be felt especially behind the breastbone, and sometimes beneath the clavicle (collarbone), neck, and left shoulder

Is a sharp, piercing pain over the center or left side of the chest that increases as the child takes a deep breath

A low-grade fever

Irritability

Fatigue

Loss of appetite

Irregular heartbeat

Children may not be able to describe that they have “chest pain” or be able to explain how they feel. Sometimes, non-specific symptoms such as irritability, loss of appetite, or fatigue will be all that the child is able to express.

The symptoms of pericarditis may resemble other medical conditions or heart problems. Always consult your child’s physician for a diagnosis.

Complications

Some of the dangerous complications of pericarditis include:

Cardiac tamponade – fluid builds up between the two layers of the pericardium. The heart is compressed and can’t function properly. This requires immediate attention and can be fatal.

Abscess A build-up of pus either within the heart or in the pericardium

Spread of infection Aas with any infection, the infection can spread to other areas

Constrictive pericarditis The pericardium is scarred by the inflammation. Scar tissue doesn’t stretch, so the heart can’t function properly.

Diagnosis and test

If your healthcare provider suspects pericarditis, he or she will listen to your heart very carefully. A common sign of pericarditis is a pericardial rub. This is the sound of the pericardium rubbing against the outer layer of your heart. Other chest sounds that are signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural effusion) may also be heard.

Your healthcare provider may also check for pulsus paradoxus. This is when your blood pressure drops when you take a deep breath. The changes in the pressure in your chest keep blood from returning from your body and entering your heart.

Along with a health history and physical exam, you may also need certain tests. These may include:

Echocardiogram (echo): This test uses sound waves to check your heart’s size and shape. The echo sound waves create a picture on a screen as an ultrasound transducer is passed over the skin over the heart. Echo can show how well your heart is working and whether fluid has built up around your heart.

Electrocardiogram (ECG): This test records the strength and timing of the electrical activity of the heart. It shows abnormal rhythms and can sometimes detect heart muscle damage. Small sensors are taped to your skin to pick up the electrical activity.

Chest X-ray: An X-ray may be done to check your lungs and see if your heart is enlarged.

Cardiac MRI: This is an imaging test that takes detailed pictures of the heart. It may be used to look for thickening or other changes in the pericardium.

Cardiac CT: This type of X-ray takes a clear, detailed picture of your heart and pericardium. It may be used to help rule out other causes of chest pain.

Blood tests: Certain blood tests can help rule out other heart problems, such as heart attack, and can tell the doctor how much inflammation there is in your body.

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