Pericarditis is the inflammation of the pericardium. This is a thin, fibrous sac that protects the heart's surface.

 

Causes

It may develop in a variety of conditions such as:

 

• infection
• trauma
• auto-immune disorders (where antibodies are made against your own tissue)
• after a heart attack or cardiac surgery.

 

Symptoms

The main symptom of pericarditis is chest pain. The type, location and severity of the pain varies among patients. It may be described as dull, sharp, aching or oppressive.

 

It is usually felt over the centre of the chest but occasionally it may be felt around the left shoulder and shoulder blade. As the nature of pain varies, patients sometimes mistakenly think they are having a heart attack.

 

Pericardial pain is usually aggravated by breathing in and coughing. It can be eased by sitting up or leaning forward.

 

Depending on the cause, other symptoms may include:

 

• shortness of breath
• fevers
• fullness in the chest
• cough, sputum
• weight loss.

 

The doctor may hear an abnormal heart sound through a stethoscope.

 

Diagnosis

Diagnosis is usually made from the signs and symptoms. An electrocardiogram (ECG) may show changes that are diagnostic of acute pericarditis. Blood tests and ultrasound examination may be helpful in confirming the diagnosis.

 

Treatment

The treatment of pericarditis depends on the cause, and on the symptoms.

 

The patient is usually asked to rest, observed regularly and given pain relief. Aspirin and anti-inflammatory medications are often prescribed.

 

Pericardial effusion 

Pericardial effusion is the accumulation of fluid in the pericardial cavity. The fluid is a result of injury and inflammation.

 

The pericardial sac normally contains less than 50 ml of fluid. The fluid may accumulate slowly, without noticeable symptoms. However, a rapidly developing effusion can stretch the pericardium to its maximum size. This can decrease cardiac output (the amount of blood that the heart pumps forward). 

 

Pericardial aspiration

Pericardial aspiration is done only when:

 

• the doctors identify a moderate to large amount of fluid, which is compressing the heart chambers, or
• a specimen of fluid is required.

 

The procedure involves inserting a needle into the pericardial space (under local anaesthetic) to withdraw fluid. In most cases of pericarditis only a small effusion is present, and aspiration is not required.

 

This information was first published in You and Your Heart - an education booklet for patients, families and friends. © 2006 Northern Sydney Central Coast Area Health Service