Pericarditis

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Overview

The pericardium is a thin layer of specialized tissue that covers the outer surfaces of the heart. This tissue helps to anchor the heart in place, prevents excessive movement of the heart in the chest when body position changes, protects the heart from infections and tumors that develop in and may spread from nearby tissues, and may help keep the heart from enlarging. Inflammation of the pericardium is called pericarditis. Pericarditis frequently causes a characteristic chest pain that usually compels one to seek medical attention.

Causes

There are many causes of pericarditis, including infection, kidney failure, metastatic disease, some medications, and radiation therapy. Recent viral infection often precedes pericarditis in young, otherwise healthy patients. In idiopathic pericarditis, no clear cause is determined.

Patients who have suffered a heart attack (myocardial infarction) may develop pericarditis over subsequent days or weeks. Kidney failure caused by the buildup of certain toxins in the body also can lead to pericarditis. Cells from tumors in other parts of the body occasionally spread (metastasize) to the pericardium, leading to irritation and inflammation. Radiation therapy (used to treat cancer) can cause pericarditis also. Pericarditis can develop in patients with diseases in which the immune system becomes pathologically overactive, such as rheumatoid arthritis and lupus. Tuberculosis was a relatively common cause of pericarditis in the past, but this is now rare.

Some medications can trigger an immune response that causes pericarditis. These medications include the antituberculosis medicine isoniazid (Nydrazid®), the hypertension and heart failure medicine hydralazine (Apresoline®), the antibiotic penicillin, the antiarrhythmic agent procainamide (Procanbid®, Pronestyl®), and the seizure medication phenytoin (Dilantin®).

Signs and Symptoms

The most common symptom of pericarditis is chest pain. The pain is predominantly felt below the breastbone (sternum) and/or below the ribs on the left side of the chest and, occasionally, in the upper back or neck. Breathing causes the lungs and heart to move in the chest and rub against the irritated pericardium, worsening the pain. Pain may worsen when patients lie down and may improve when they sit up and lean forward. Changes in position can increase or decrease pressure on and irritation of the inflamed pericardium.

Several things that cause pericarditis also cause fluid to accumulate between the pericardium and the heart (pericardial effusion). If enough fluid builds up quickly in this space, it can "compress" the heart's chambers. Through some fairly complex mechanisms, this sometimes leads to shortness of breath (dyspnea). The development of dyspnea is a matter of concern because it may indicate that the amount of fluid is reaching a critical point and requires urgent medical treatment.

While pericarditis usually is not a life-threatening condition, other life-threatening conditions may cause chest pain, including heart attack (myocardial infarction), dissection of the aorta ("tearing" of the body's main artery that runs through the chest and abdomen), blood clot lodged in the lung (pulmonary embolus), a collapsed lung, and perforation or rupture of parts of the digestive tract (e.g., esophagus, stomach). It is critical for anyone who experiences chest pain to seek immediate medical attention to determine the cause and receive prompt, appropriate treatment.

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