Pericarditis

Causes

In most cases, why pericarditis occurs is unknown. However, it can result from one or more of these:

• a viral, bacterial or fungal infection
• heart attack
• cancer spreading from a nearby tumor in the lung, breast or the blood
• radiation treatment
• injury or surgery

Sometimes it accompanies rheumatoid arthritis, lupus (systemic lupus erythematosus) (e-rith"eh-mah-TO'sus) and kidney failure.

Signs and symptoms

The most common symptom is chest pain. This pain is usually located in the middle or left side of the chest. The pain may increase with deep breathing, with swallowing, or when lying flat on your back. Other symptoms are shortness of breath, fever, chills, and sweating.

While you are hospitalized, the physician will listen to your heart frequently for new heart sounds that may develop.

Diagnosis

Your child's physician may have heard an abnormal heart sound called a rub, which occurs when there is irritation of the pericardial membranes. In addition to a complete medical history and physical examination, diagnostic for pericarditis may include:

• blood tests (to evaluate the degree of inflammation).
• chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• echocardiography (echo) - a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves.

Treatment

The goal of treatment is to relieve symptoms and manage underlying systemic disease.

Bed rest and drug therapy

In acute idiopathic pericarditis, post-MI pericarditis, and postthoracotomy pericarditis, treatment consists of bed rest as long as fever and pain persist and nonsteroidal anti-inflammatory drugs, such as aspirin and indomethacin, to relieve pain and reduce inflammation.

If these drugs fail to relieve symptoms, corticosteroids may be used. Although corticosteroids produce rapid and effective relief, they must be used cautiously because episodes may recur when therapy is discontinued.

Infectious pericarditis that results from disease of the left pleural space, mediastinal abscesses, or septicemia requires antibiotics (possibly by direct pericardial injection), surgical drainage, or both. Cardiac tamponade may require pericardiocentesis. Signs of tamponade include pulsus paradoxus, neck vein distention, dyspnea, and shock.

Pericardectomy

Recurrent pericarditis may necessitate partial pericardectomy, which creates a ''window'' that allows fluid to drain into the pleural space. In constrictive pericarditis, total pericardectomy to permit adequate filling and contraction of the heart may be necessary. Treatment must also include management of rheumatic fever, uremia, tuberculosis, and other underlying disorders.

Prevention

Many cases may not be preventable. Treat respiratory infections and other disorders promptly.