Pericarditis

The heart is contained in a sac called the pericardium. Just like in pleurisy, this sac can become inflamed and cause pain. As opposed to angina, this pain tends to be sharp and is due to the inflamed sac rubbing against the outer layers of the heart.


The most common cause of pericarditis is either a viral illness or is unknown (idiopathic). Inflammatory diseases of the body (rheumatoid arthritis, systemic lupus erythematosus), kidney failure, and cancer are other conditions that can cause pericarditis. Trauma, especially from steering wheel injuries in motor vehicle accidents can cause pericarditis.

The pain with pericarditis is intense, sharp, tends to be worse when lying down, and is relieved by leaning forward. Because the pain can be so severe, radiate to the arm or neck, and cause some shortness of breath, it is sometimes mistaken for angina, pulmonary embolus, or aortic dissection. Associated symptoms include fever and malaise.

History is helpful in making the diagnosis, looking for a recent viral illness and asking about past medical history. Physical examination may reveal a friction rub when listening to the heart sounds.

The electrocardiogram may show changes consistent with pericarditis, but on occasion, the EKG may mimic an acute heart attack. Echocardiogram is helpful if there is fluid in the pericardial sac associated with the inflammation.

An anti-inflammatory medication like ibuprofen is the treatment for pericarditis. Addressing the underlying cause will also direct therapy.

Cardiac tamponade is a complication of pericarditis. Pressure from excess fluid built up in the pericardial sac is so great that it prevents blood from returning to heart. The diagnosis is made clinically with the triad of (Beck's triad):

• low blood pressure,


• distention of neck veins, and


• muffled heart tones.
  

Treatment is placing a needle into the pericardium to withdraw fluid and/or surgery to open a window in the pericardium to prevent future fluid buildup. For more, please read the Pericarditis article.

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