Acute Pericarditis

The heart is enclosed in a flexible, two-layered sac called the pericardium. The pericardium keeps the heart in place, prevents it from filling with too much blood and protects the heart against chest infections.

When the pericardium becomes inflamed (red and tender) and fluid and blood cells fill the space between its two layers, the condition is called pericarditis. If the condition comes on suddenly, it is called acute pericarditis.

Acute pericarditis is inflammation of the pericardium that begins suddenly, is often painful, and causes fluid and blood components such as fibrin, red blood cells, and white blood cells to pour into the pericardial space.

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Symptoms

While some types of acute pericarditis can begin with few or no symptoms, it most often causes the following symptoms:

  • Chest pain that usually runs to the left shoulder and sometimes down the left arm. The pain may be like that of a heart attack except that it gets worse when lying down, swallowing food, coughing or breathing deeply.
  • Fever
  • Rising blood pressure if the fluid or blood that collects between the layers of the pericardium interferes with its ability to pump blood. If the pressure gets too high, a life-threatening complication, cardiac tamponade, may develop.

There may be no symptoms at the beginning of acute pericarditis that develops due to tuberculosis. It may produce fever and symptoms of heart failure.

When acute pericarditis is caused by virus infection, it is usually painful, but goes away in a short time without lasting effects.

If acute pericarditis develops a day or two after a heart attack, the focus is on the larger issue of the heart attack. If acute pericarditis develops in the period 10 days to two months after a heart attack, symptoms include:

  • Fever
  • Fluid collecting in the space between the two layers of membrane that cover the lungs (the pleura)
  • Fluid collecting in the space between the two layers of the pericardium,
  • Inflammation (tenderness and swelling) of the membranes that cover the lungs (the pleura)
  • Joint pain

Causes and Risk Factors

Usually acute pericarditis develops as a result of an infection or other condition that irritates the pericardium.

Infections that cause pericarditis are usually due to viruses but may be caused by bacteria, parasites (including protozoa) or fungi. AIDS, because it impairs the immune system and makes the body vulnerable to infections, can be associated with pericarditis.

Conditions that can irritate the pericardium and lead to acute pericarditis include:

  • Heart attack. Acute pericarditis can develop in the first day or two or after 10 days to two months after a heart attack.
  • Blood leaking from an aortic aneurysm (a bulge in the wall of the aorta)
  • Cancer (such as leukemia or Kaposi's sarcoma)
  • Certain drugs, including anticoagulants, penicillin, procainamide (an antiarrhythmic drug), phenytoin (an anticonvulsant) and phenylbutazone (a nonsteroidal anti-inflammatory drug)
  • Heart surgery
  • Injury
  • Kidney failure
  • Lupus
  • Radiation therapy
  • Rheumatic fever
  • Rheumatoid arthritis
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Diagnosis

Your doctor will take note of your symptoms and your medical history and do a physical examination. He or she will listen to your chest using a stethoscope. Pericarditis can produce a crunching or rustling sound like that of the creaking of a leather shoe or the rustling of dry leaves.

In addition, he or she may order:

  • A chest X-ray
  • Blood tests, which may be helpful in identifying some of the conditions that can cause pericarditis such as leukemia, AIDS, infections, rheumatic fever or kidney failure
  • Echocardiogram, which can detect too much fluid in the space between the layers of the pericardium or help identify a cause for the condition such as cancer
  • Electrocardiogram (ECG)