Pericarditis

Pericarditis is swelling (inflammation) of the pericardium - the sac which surrounds the heart. Pericarditis causes chest pains. Most cases are due to a viral infection which usually goes away within a few weeks. The only treatment usually needed for a 'viral pericarditis' is anti-inflammatory medication. There are some less common causes of pericarditis which may need other treatments. Complications are uncommon, but can be serious.

What are the pericardium and pericarditis

The pericardium is a thin sac-like tissue that covers the outer surface of the heart. It helps to anchor the heart in place, and prevents the heart from moving in the chest when you move. The pericardium has an inner and outer layer. There is a thin layer of 'lubricating' fluid between the two layers. Pericarditis means swelling (inflammation) of the pericardium.

What are the causes of pericarditis

Viral infection

Infection with a virus is the most common cause. Several different viruses can cause pericarditis, including Coxsackieviruses, echoviruses, influenza viruses, adenoviruses, the mumps virus, human immunodeficiency virus (HIV) and viruses that cause hepatitis.

Other causes are uncommon and include:

  • Infection with a germ (bacterium). This often causes pus to form between the inner and outer layers of the pericardium. The infection has usually spread from nearby tissues (such as an infection of the heart itself) or from a wound infection following heart surgery. Rarely, syphilis or fungi can infect the pericardium.
  • Tuberculosis (TB) infection. This is usually as part of a more widespread TB infection in the lungs and other parts of the body.
  • Uraemic pericarditis. This is swelling (inflammation) caused by waste products building up in the bloodstream in people with untreated kidney failure.
  • Heart attack (myocardial infarction). Inflammation of the pericardium may occur if there is damage to nearby heart tissue, caused by a heart attack.
  • Following heart surgery. Inflammation can occur a few days to a few weeks after open heart surgery.
  • Following injury. For example, following a stab wound, or a severe blow to the chest.
  • Inflammatory diseases which can affect various parts of the body may include inflammation of the pericardium. For example, rheumatoid arthritis, scleroderma, polyarteritis nodosa, and systemic lupus erythematosus (SLE).
  • Radiotherapy to treat cancers in the chest.
  • Cancer which has spread to the pericardium from another part of the body (this is very rare).

Idiopathic pericarditis

In many cases, no cause can be found. This is called idiopathic pericarditis. Many of these cases are probably caused by a viral infection which is not able to be identified.

What are the symptoms of pericarditis

Symptoms of viral and idiopathic pericarditis: The typical symptoms are chest pain and high temperature (fever). The pain is usually in the middle of the chest or slightly left of centre. It may feel sharp and stabbing. Sometimes it is a persistent steady pain. The pain may spread to the neck and/or shoulders. Typically, the pain gets worse if you take a deep breath, swallow, cough, or lie down. The pain may ease if you sit up or lean forward.You may also feel breathless, especially if tamponade develops (see below).

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