Inflammation of pericardium, the sac that surrounds the heart. Note: cardiac conditions are inherently unstable. This program was developed for animal research only.HeartEncyclopedia Entry for Pericarditis :Pericarditis - after heart attack. Two types of pericarditis can occur after a heart attack. Early pericarditis: This form most occurs within 1 to 3 days after a heart attack. Inflammation and swelling develop as the body tries to clean up the diseased heart tissue. Late pericarditis: This is also called Dressler syndrome. It is also called post-cardiac injury syndrome or postcardiotomy pericarditis). It most often develops several weeks or months after a heart attack, heart surgery, or other trauma to the heart. It can also happen a week after a heart injury. Dressler syndrome is thought to occur when the immune system attacks healthy heart tissue by mistake. Post-MI pericarditis is inflammation of the pericardium (the sac-like covering of the heart). Any previous injury to the heart muscle can cause pericarditis. Incidences of pericarditis are associated with Dressler Things that put you at higher risk of pericarditis include: A previous heart attack Open heart surgery Chest trauma A heart attack that has affected the thickness of your heart muscle.Symptoms include: Anxiety Chest pain from the swollen pericardium rubbing on the heart. The pain may be sharp, tight or crushing and may move to the neck, shoulder, or abdomen. The pain may also be worse when you breathe and go away when you lean forward, stand, or sit up. Trouble breathing Dry cough Fast heart rate (tachycardia) Fatigue Fever (common with the second type of pericarditis) Malaise (general ill feeling) Splinting of ribs (bending over or holding the chest) with deep breathing.The health care provider will listen to your heart and lungs with a stethoscope. There may be a rubbing sound (called a pericardial friction rub, not to be confused with a heart murmur). Heart sounds in general may be weak or sound far away. A buildup of fluid in the covering of the heart or space around the lungs (pericardial effusion) is not common after a heart attack. But, it often does occur in some people with Dressler syndrome. Tests may include: Cardiac injury markers (CK-MB and troponin may help tell pericarditis from a heart attack) Chest CT scan Chest MRI Chest x-ray Complete blood count ECG (electrocardiogram) Echocardiogram ESR (sedimentation rate) or C-reactive protein (measures of inflammation).The goal of treatment is to make the heart work better and reduce pain and other symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin may be used to treat inflammation of the pericardium. A drug called colchicine is often used with these medicines. Steroids are commonly used for Dressler syndrome. They are not often used for early pericarditis unless the condition does not respond to other treatment. In some cases, excess fluid surrounding the heart (pericardial effusion) may need to be removed. This is done with a procedure called pericardiocentesis. If complications develop, part of the pericardium may need to be removed with surgery (pericardiectomy). The pericardial sac surrounds and protects the heart within the chest cavity.The condition may come back, even in people who get treatment. Untreated pericarditis can be life threatening in some cases.Possible complications of pericarditis are: Cardiac tamponade Congestive heart failure Constrictive pericarditis.Call your provider if: You develop symptoms of pericarditis after a heart attack You have been diagnosed with pericarditis and symptoms continue or come back despite treatment.Dressler syndrome; Post-MI pericarditis; Post-cardiac injury syndrome; Postcardiotomy pericarditis.Acute MI Acute MI Pericardium Pericardium Post-MI pericarditis Post-MI pericarditis Pericardium Pericardium.Imazio M, Brucato A, Forno D, et al. Efficacy and safety of colchicine for pericarditis prevention. Systematic review and meta-analysis. Heart. 2012;98(14):1078-1082. PMID: 22442198 www.ncbi.nlm.nih.gov/pubmed/22442198. LeWinter MM, Hopkins WE. Pericardial diseases.Encyclopedia Entry for Pericarditis :Pericarditis - constrictive. Most of the time, constrictive pericarditis occurs due to things that cause inflammation to develop around the heart, such as: Heart surgery Radiation therapy to the chest Tuberculosis Less common causes include: Abnormal fluid buildup in the covering of the heart. This may occur because of infection or as a complication of surgery. Mesothelioma The condition may also develop without a clear cause. It is rare in children. Constrictive pericarditis.When you have constrictive pericarditis, the inflammation causes the covering of the heart to become thick and rigid. This makes it hard for the heart to stretch properly when it beats. As a result, the heart chambers don't fill up with enough blood. Blood backs up behind the heart, causing heart swelling and other symptoms of heart failure. Symptoms of chronic constrictive pericarditis include: Difficulty breathing ( dyspnea ) that develops slowly and gets worse Fatigue Long-term swelling ( edema ) of the legs and ankles Swollen abdomen Weakness.Constrictive pericarditis is very hard to diagnose. Signs and symptoms are similar to other conditions such as restrictive cardiomyopathy and cardiac tamponade. Your health care provider will need to rule out these conditions when making a diagnosis. A physical exam may show that your neck veins stick out. This indicates increased pressure around the heart. When it happens due to constrictive pericarditis that is called Kussmaul's sign. The provider may note weak or distant heart sounds when listening to your chest with a stethoscope. A knocking sound may also be heard. The physical exam may also reveal liver swelling and fluid in the belly area. The following tests may be ordered: Chest MRI Chest CT scan Chest x-ray Coronary angiography or cardiac catheterization ECG Echocardiogram.The goal of treatment is to improve heart function. The cause must be identified and treated. Depending on the source of the problem, treatment may include antibiotics, medicines for tuberculosis, or other treatments. Diuretics ('water pills') are often used in small doses to help the body remove excess fluid. Pain medicines may be needed for discomfort. Some people may need to cut down on their activity. A low-sodium diet may also be recommended. If other methods DO NOT control the problem, surgery called a pericardiectomy may be needed. This involves cutting or removing the scarring and part of the sac-like covering of the heart.Constrictive pericarditis may be life threatening if untreated. However, surgery to treat the condition has a high risk for complications. For this reason, it is most often done in people who have severe symptoms.Complications may include: Cardiac tamponade Damage to the coronary arteries Heart failure Pulmonary edema Scarring of the heart muscle.Call your provider if you have symptoms of constrictive pericarditis.Constrictive pericarditis in some cases is not preventable. However, conditions that can lead to constrictive pericarditis should be properly treated.Constrictive pericarditis.Pericardium Pericardium Constrictive pericarditis Constrictive pericarditis.Jouriles NJ. Pericardial and Myocardial Disease. In Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier Saunders; 2018:chap 72. LeWinter MM, Imazio M. Pericardial diseases.Encyclopedia Entry for Pericarditis :Pericarditis. The cause of pericarditis is unknown or unproven in many cases. It mostly affects men ages 20 to 50 years. Pericarditis is often the result of an infection such as: Viral infections that cause a chest cold or pneumonia Infections with bacteria (less common) Some fungal infections (rare) The condition may be seen with diseases such as: Cancer (including leukemia) Disorders in which the immune system attacks healthy body tissue by mistake HIV infection and AIDS Underactive thyroid gland Kidney failure Rheumatic fever Tuberculosis (TB) Other causes include: Heart attack Heart surgery or trauma to the chest, esophagus, or heart Certain medicines, such as procainamide, hydralazine, phenytoin, isoniazid, and some drugs used to treat cancer or suppress the immune system Swelling or inflammation of the heart muscle Radiation therapy to the chest.Chest pain is almost always present. The pain: May be felt in the neck, shoulder, back, or abdomen Often increases with deep breathing and lying flat, and may increase with coughing and swallowing Can feel sharp and stabbing Is often relieved by sitting up and leaning or bending forward You may have fever, chills, or sweating if the condition is caused by an infection. Other symptoms may include: Ankle, feet, and leg swelling Anxiety Breathing difficulty when lying down Dry cough Fatigue.When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of excess fluid in the pericardium (pericardial effusion). If the disorder is severe, there may be: Crackles in the lungs Decreased breath sounds Other signs of fluid in the space around the lungs The following imaging tests may be done to check the heart and the tissue layer around it (pericardium): Chest MRI scan Chest x-ray Echocardiogram Electrocardiogram Heart MRI or heart CT scan Radionuclide scanning To look for heart muscle damage, the provider may order a troponin I test. Other laboratory tests may include: Antinuclear antibody (ANA) Blood culture CBC C-reactive protein Erythrocyte sedimentation rate ( ESR ) HIV test Rheumatoid factor Tuberculin skin test.The cause of pericarditis should be identified, if possible. High doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often given with a medicine called colchicine. These medicines will decrease your pain and reduce the swelling or inflammation in the sac around your heart. If the cause of pericarditis is an infection: Antibiotics will be used for bacterial infections Antifungal medicines will be used for fungal pericarditis Other medicines that may be used are: Corticosteroids such as prednisone (in some people) 'Water pills' (diuretics) to remove excess fluid If the buildup of fluid makes the heart function poorly, treatment may include: Draining the fluid from the sac. This procedure, called pericardiocentesis, may be done using a needle, which is guided by ultrasound (echocardiography) in most cases. Cutting a small hole (window) in the pericardium (subxiphoid pericardiotomy) to allow the infected fluid to drain into the abdominal cavity. This is done by a surgeon. Surgery called pericardiectomy may be needed if the pericarditis is long-lasting, comes back after treatment, or causes scarring or tightening of the tissue around the heart. The operation involves cutting or removing part of the pericardium.Pericarditis can range from mild illness that gets better on its own, to a life-threatening condition. Fluid buildup around the heart and poor heart function can complicate the disorder. The outcome is good if pericarditis is treated right away. Most people recover in 2 weeks to 3 months. However, pericarditis may come back. This is called recurrent, or chronic, if symptoms or episodes continue. Scarring and thickening of the sac-like covering and the heart muscle may occur when the problem is severe. This is called constrictive pericarditis. It can cause long-term problems similar to those of heart failure.Call your provider if you have symptoms of pericarditis. This disorder is not life threatening most of the time. However, it can be very dangerous if not treated.Many cases cannot be prevented.Pericardium Pericardium Pericarditis Pericarditis.Imazio M, Gaita F, LeWinter M. Evaluation and treatment of pericarditis: A systematic review. JAMA. 2015; 314(14):1498-1506. PMID: 26461998 www.ncbi.nlm.nih.gov/pubmed/26461998. Knowlton KU, Narezkina A, Savoia MC, Oxman MN. Myocarditis and pericarditis.