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Heart disease: Pericardial disease (pericarditis)

Pericardial disease, or pericarditis, is the inflammation of any of the layers of the pericardium. The pericardium is a thin fibrous membrane sac that surrounds the heart. The pericardium consists of:

  • An inner layer (visceral pericardium) that surrounds the heart.
  • An outer layer (parietal pericardium) comprising the outer fibrous sac.
  • A middle fluid layer to prevent friction between the parietal pericardium and visceral pericardium.

What causes pericarditis?

Causes of pericarditis include:

  • Infections
  • Heart surgery
  • Heart attack
  • Serious injury
  • Tumours
  • Cancer
  • Radiotherapy
  • Autoimmune diseases (such as rheumatoid arthritis, lupus, or scleroderma)

For some people, no cause can be found.

Pericarditis can be acute (occurring suddenly) or chronic (ongoing).

What are the symptoms of pericarditis?

When present, they may include:

  • Chest pain. This pain is different from angina (pain caused by coronary artery disease). It may be sharp and located in the centre of the chest. The pain may radiate to the neck and shoulders, and occasionally, the arms and back. It is made worse when lying down, coughing, or swallowing and relieved by leaning forward.
  • High temperature.
  • Increased heart rate.

How is pericarditis diagnosed?

Your doctor can diagnose pericarditis based on:

  • Reported symptoms
  • Physical examination
  • Electrocardiography (ECG) results 

Other tests may be performed to determine the cause of pericarditis.

How is pericarditis treated?

Treatment is based on the cause and may include:

  • Nonsteroidal anti-inflammatory agents ( NSAIDs) to decrease the pain and inflammation.
  • Steroids, used occasionally for severe attacks.
  • Antibiotics, if the pericarditis is due to infection.

Most patients recover in two to four weeks.

What is constrictive pericarditis?

Constrictive pericarditis is a rare complication of pericarditis.

The pericardium becomes very thick or scarred.

What are the symptoms of constrictive pericarditis?

The symptoms are the same as pericarditis, with the addition of:

  • Shortness of breath.
  • Fatigue (feeling overtired).
  • Heart failure symptoms (swelling of legs and feet, unexplained weight gain).
  • Atrial fibrillation

How is constrictive pericarditis diagnosed?

The same tests used to diagnose pericarditis are used to diagnose constrictive pericarditis. Other diagnostic tests used for constrictive pericarditis include:

  • Echocardiography
  • Chest X-ray
  • MRI
  • CT scan

How is constrictive pericarditis treated?

Treatment may include:

  • Analgesics and anti-inflammatory agents to treat pain or inflammation.
  • Diuretics to treat heart failure symptoms.
  • Antiarrhythmics to treat any heart arrhythmias, such as atrial fibrillation
  • Pericardiotomy (the surgical removal of the stiff pericardium from the heart).
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WebMD Medical Reference

Medically Reviewed by Dr Rob Hicks on August 30, 2012

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