April 23, 2016


The Pericardium
The pericardium is a thin, two-layered, fluid-filled sac that covers the outer surface of the heart. It shields the heart from infection or malignancy and contains the heart in the chest wall. It also prevents the heart from over-expanding when blood volume increases, which keeps the heart functioning efficiently.
What is pericarditis?
Pericarditis is an inflammation of the pericardium. Pericarditis is usually acute – it develops suddenly and may last up to several months. If you could see and touch it, the membrane around the heart would look red and swollen, like the skin around a cut that becomes inflamed. Sometimes excess fluid develops in the space between the pericardial layers and causes a pericardial effusion (buildup of excess fluid around the heart).

What are the symptoms of pericarditis?
Chest pain symptoms associated with pericarditis can be described as:
   -Sharp and stabbing (caused by the heart rubbing against the pericardium)
    -May increase with coughing, swallowing, deep breathing or lying flat
    -Can be relieved by sitting up and leaning forward
    -You also may feel the need to bend over or hold your chest to breathe more comfortably.
Other symptoms include:
    -Pain in the back, neck or left shoulder
    -Difficulty breathing when lying down
    -A dry cough
    -Anxiety or fatigue
In some people, pericarditis can cause
    -swelling of the feet, legs or ankles. This swelling may be a symptom of constrictive pericarditis, a serious type of pericarditis. In constrictive pericarditis, the patient’s pericardium hardens and/or thickens, preventing the heart muscle from expanding and affecting the function of the heart. The heart may be compressed by the constrictive process, which may cause blood to back up into the lungs, abdomen and legs, as well as cause the swelling.
If you have any symptoms of acute pericarditis, it is important to call your doctor right away.
If you feel your symptoms are a medical emergency, do not wait for an appointment. Call for help immediately and ask to be transported to the nearest hospital.
Who gets pericarditis?
Most cases of pericarditis occur in men aged 20 to 50, although pericarditis also can occur in women.
What causes pericarditis?
There are many causes of pericarditis, but it is often a complication of a viral infection (viral pericarditis) – usually a gastrointestinal virus, or rarely the flu virus or AIDS. It may also be caused by a bacterial infection (bacterial pericarditis), fungal infection (fungal pericarditis) or parasitic infection (parasitic pericarditis).
Certain autoimmune diseases, such as lupus, rheumatoid arthritis and scleroderma, also can cause pericarditis. Additional causes of pericarditis include injury to the chest such as after a car accident (traumatic pericarditis), other health problems such as kidney failure (uremic pericarditis), tumors, genetic diseases such as Familial Mediterranean Fever (FMF), or rarely, medications that suppress the immune system.
The risk of pericarditis is greater after a heart attack or after heart surgery (Dressler’s syndrome), radiation therapy or a percutaneous treatment, such as cardiac catheterization or radiofrequency ablation (RFA).
In these cases, many experts believe that pericarditis is the result of the body mistakenly producing an inflammatory response to the pericardium. After bypass surgery, symptoms of pericarditis may not occur until several weeks after surgery.
In many cases of pericarditis, the cause is unknown. Pericarditis with an unknown cause is referred to as idiopathic pericarditis.
Pericarditis often becomes recurrent after the initial episode and attacks can last over many years.
When should I see my doctor?
If you have any of the symptoms of acute pericarditis, you should schedule an exam with your doctor immediately. Left untreated, pericarditis can become a life-threatening condition because pericardial effusion can develop and possibly lead to cardiac tamponade (a severe compression of the heart that impairs its ability to function).
Symptoms of cardiac tamponade include chest pain, difficulty breathing, fainting, light-headedness, palpitations or rapid breathing. These symptoms require emergent treatment; call for emergency if you experience any of these symptoms.
If you develop symptoms of constrictive pericarditis, including shortness of breath, swelling of the legs and feet, water retention, heart palpitations, and severe swelling of the abdomen, you should make an appointment with your cardiologist for an evaluation.
How is pericarditis diagnosed?
You doctor will start with an evaluation of your symptoms: the sharp pain in the chest and back of the shoulders, and difficulty breathing are two major clues that you may have pericarditis rather than a heart attack. Your doctor also will ask you about your medical history, such as whether you have had a recent viral illness. He or she should already know about any previous heart surgery or current diseases, such as lupus or kidney failure, that may increase your risk of pericarditis.
During a physical exam, the doctor will listen to your heart with a stethoscope. Pericarditis may cause a rubbing or creaking sound, called the “pericardial rub,” that is produced by the rubbing of the inflamed lining of the pericardium. This is best heard when the patient leans forward while holding his or her breath, and when breathing out. Depending on how severe the inflammation is, your doctor may also hear crackles in the lungs, signs of fluid in the space around the lungs, or excess fluid in the pericardium.
Diagnostic tests may include:
Chest X-ray: Shows evidence of enlargement of the heart and congestion of the lungs.
Electrocardiogram (ECG or EKG): Shows changes in your normal heart rhythm that may indicate you have pericarditis. In about half of the patients with pericarditis, the heart rhythm goes through a sequence of four distinct patterns, but all patients with pericarditis will have some of the changes.
Echocardiogram (echo): Shows the heart function and may show evidence of fluid or pericardial effusion around the heart. It will also show the classic signs of constrictive pericarditis when present (including stiffening or thickening of the pericardium that constricts the heart’s normal movement).
Cardiac MRI and CT scan: Show excess fluid in the pericardium or signs of pericardial inflammation using a special imaging agent called gadolinium. These tests may also show a thickened pericardium or compression of the heart from the thickened pericardium.
Cardiac catheterization: Provides hemodynamic information about the filling pressures within the heart in order to confirm a diagnosis of constrictive pericarditis.
Laboratory (blood) tests: Can be used to make sure you are not having a heart attack, to evaluate the heart’s function, test the fluid in the pericardium and determine the underlying cause of the pericarditis. Often, the sedimentation rate (ESR) or C reactive protein levels (markers of inflammation) are elevated. Other laboratory tests may include evaluation for autoimmune diseases.

No comments: