What do Doctors call this Condition - Pericarditis

What is this Condition?

In this disease, the pericardium - the sac that envelops, supports, and protects the heart - becomes inflamed. It occurs in both acute and chronic forms. Acute inflammation may be marked by the build­up of fluid that may contain pus or blood. In chronic constrictive inflammation, the pericardium becomes thickened and fibrous, restricting heart motion. The prognosis depends on the underlying cause but is generally good in acute inflammation.

What Causes it?

Common causes of this disease include:

• bacterial, fungal, or viral infection

• cancers (primary or spread from the lungs, breasts, or other organs)

• high-dose radiation to the chest

• uremia (an excess of waste products in the blood produced by the metabolism of protein)

• hypersensitivity or autoimmune disease, such as acute rheumatic fever (most common cause of inflammation of the sac around the heart in children), lupus, and rheumatoid arthritis

• injury to the pericardial sac, which may result from a heart attack (which later causes an autoimmune reaction in the pericardium), trauma, or surgery that leaves the pericardium intact but causes blood to leak into the pericardial cavity

• such drugs as Apresoline and Pronestyl.

What are its Symptoms?

Acute inflammation of the sac around the heart typically produces a sharp and often sudden pain that usually starts over the sternum and radiates to the neck, shoulders, back, and arms. However, unlike the pain of a heart attack, pericardial pain often increases with deep inspiration and decreases when the person sits up and leans forward.

A major complication of this disorder is pericardial effusion.

How is it Diagnosed?

Because inflammation of the sac around the heart often exists with other conditions, its diagnosis depends on typical signs and symptoms and elimination of other possible causes. When listening with a stethoscope, the doctor may hear a grating sound as the heart moves, called a pericardial friction rub. In addition, if acute inflammation has caused accumulation of fluid in the pericardial sac, the doctor may note changes in sounds produced by the heart - increased cardiac dullness, diminished or absent apical impulse, and distant heart sounds.

Diagnostic test results, such as white blood cell count and measurement of cardiac enzymes, may help to confirm inflammation and identifY its cause. Open surgical drainage or cardiocentesis may be performed to obtain a culture of pericardial fluid. Culturing may help to identifY a causative organism in bacterial or fungal inflammation. An electrocardiogram may show changes in heart rate and rhythm brought on by acute inflammation.

How is it Treated?

The goal of treatment is to relieve symptoms and manage underlying systemic disease. When this condition is caused by a heart attack or follows heart surgery, treatment consists of bed rest as long as fever and pain persist and nonsteroidal anti-inflammatory drugs, such as aspirin and Indocin, to relieve pain and reduce inflammation. If these drugs fail to relieve symptoms, corticosteroids may be used.

Antibiotics, surgical drainage, or both may be needed to treat infectious inflammation of the sac around the heart. If cardiac tamponade (increased pressure on the heart muscle from fluid buildup) develops, the doctor may perform emergency pericardiocentesis.

Recurrent inflammation of the sac around the heart may require partial pericardiectomy, which creates a “window” that allows fluid to drain. In constrictive inflammation, total pericardiectomy (removal of the sac around the heart) may be necessary to permit adequate filling and contraction of the heart.