pericarditis (redirected from Pericarditus)

Pericarditis 

Definition

Pericarditis is an inflammation of the two layers of the thin, sac-like membrane that surrounds the heart. This membrane is called the pericardium, so the term pericarditis means inflammation of the pericardium.

Description

Pericarditis is fairly common. It affects approximately one in 1,000 people. The most common form is caused by infection with a virus. People in their 20s and 30s who have had a recent upper respiratory infection are most likely to be affected, along with men aged 20-50. One out of every four people who have had pericarditis will get it again, but after two years these relapses are less likely.

Causes and symptoms

The viruses that cause pericarditis include those that cause influenza, polio, and rubella (German measles). In children, the most common viruses that cause pericarditis are the adenovirus and the cocksackievirus (which is most likely to affect children during warmer weather).

Although pericarditis is usually caused by a virus, it also can be caused by an injury to the heart or it can follow a heart attack. It may also be caused by certain inflammatory diseases such as rheumatoid arthritis or systemic lupus erythematosus. Bacteria, fungi, parasites, tuberculosis, cancer or kidney failure may also affect the pericardium. Sometimes the cause is unknown.

There are several forms of pericarditis, depending on the cause.

Acute pericarditis

This is caused by infection with a virus, bacteria, or fungus—usually in the lungs and upper respiratory tract. This form of the disease causes a sharp, severe pain that starts in the region of the breastbone. If the pericarditis is caused by a bacteria, it is called bacterial or purulent pericarditis.

Cardiac tamponade

Sometimes fluid collects between the heart and the pericardium. This is called pericardial effusion, and may lead to a condition called cardiac tamponade. When the fluid accumulates, it can squeeze the heart and prevent it from filling with blood. This keeps the rest of the body from getting the necessary supply of oxygen and can cause dangerously low blood pressure. A cardiac tamponade can happen when the chest is injured during surgery, radiation therapy, or an accident. Cardiac tamponade is a serious medical emergency and must be treated immediately.

Constrictive pericarditis

When the pericardium is scarred or thickened, the heart has difficulty contracting. This is because the pericardium has shrunken or tightened around the heart, constricting the muscle's heart movement. This usually occurs as a result of tuberculosis, which now is rarely found in the United States, except in immigrant, AIDS, and prison populations.

Symptoms of pericarditis

Symptoms likely to be associated with pericarditis include:

• rapid breathing
• breathlessness
• dry cough
• fever and chills
• weakness
• broken blood vessels (hemorrhages) in the mucus membrane of the eyes, the back, the chest, fingers, and toes
• feelings of anxiety
• A sharp or dull pain that starts in the front of the chest under the breastbone and radiates to the left side of the neck, upper abdomen, and left shoulder the pain is less intense when the patient sits up or leans forward and worsens when lying down; it may worsen with a deep breath, like pleurisy, which may accompany pericarditis

In cardiac tamponade, neck veins may be swollen and blood pressure may be very low.

Diagnosis

The heart of a person with pericarditis is likely to produce a grating sound (friction rub) when heard through a stethoscope. This sound occurs because the roughened pericardium surfaces are rubbing against each other.

The following tests will also help diagnose pericarditis and what is causing it:

• electrocardiograph (ECG) and echocardiogram to distinguish between pericarditis and a heart attack.
• x ray to show the traditional "water bottle" shadow around the heart that is often seen in pericarditis where there is a sufficient fluid build up.
• computed tomography scan (CT scan) of the chest.
• heart catheterization to view the heart's chambers and valves.
• pericardiocentesis to test for viruses, bacteria, fungus, cancer, and tuberculosis.
• blood tests such as LDH and CPK to measure cardiac enzymes and distinguish between a heart attack and pericarditis, as well as a complete blood count (CBC) to look for infection.

Treatment

Since most pericarditis is caused by a virus and will heal naturally, there is no specific, curative treatment. Ordinary antibiotics do not work against viruses. Pericarditis that comes from a virus usually clears up in two weeks to three months. Medications may be used to reduce inflammation, however. They include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. Corticosteroids are helpful if the pericarditis was caused by a heart attack or systemic lupus erythematosus. Analgesics (painkillers such as aspirin or acetaminophen) also may be given.

If the pericarditis recurs, removal of all or part of the pericardium (pericardiectomy) may be necessary. In the case of constrictive pericarditis, the pericardiectomy may be necessary to remove the stiffened

Cardiac tamponade occurs when fluid collects in the pericardial sac between the heart and the surrounding pericardium. A medical emergency, cardiac tamponade deprives the body of oxygen and requires immediate treatment.

(Illustration by Electronic Illustrators Group.)

parts of the pericardium that are preventing the heart from beating correctly.

If a cardiac tamponade is present, it may be necessary to drain excess fluid from the pericardium. Pericardiocentesis, the same procedure used for testing, will be used to withdraw the fluid.

For most people, home care with rest and medications to relieve pain are sufficient. A warm heating pad or compress also may help relieve pain. Sitting in an upright position and bending forward helps relieve discomfort. A person with pericarditis may also be kept in bed, with the head of the bed elevated to reduce the heart's need to work hard as it pumps blood. Along with painkillers and antibiotics, diuretic drugs ("water pills") to reduce fluids may also be used judiciously.

Prognosis

Prognosis is good. Most people recover within three weeks to several months and do not need any additional treatment.

Key terms

Computed tomography (CT) scan — A CT scan uses x rays to scan the body from many angles. A computer compiles the x rays into a picture of the area being studied. The images are viewed on a monitor and printed-out.

Echocardiogram — An echocardiogram bounces sound waves off the heart to create a picture of its chambers and valves.

Electrocardiogram (ECG) — An ECG is a test to measure electrical activity in the heart.

Heart catheterization — A heart catheterization is used to view the heart's chamber and valves. A tube (catheter) is inserted into an artery, usually in the groin. A dye is then put into the artery through the tube. The dye makes its way to the heart to create an image of the heart on x-ray film. The image is photographed and stored for further examination.

Pericardiocentesis — Pericardiocentesis is a procedure used to test for viruses, bacteria, and fungus. The physician puts a small tube through the skin, directly into the pericardial sac, and withdraws fluid. The fluid then is tested for viruses, bacteria, and fungus.

Pericardium — The pericardium is the thin, sac-like membrane that surrounds the heart. It has two layers: the serous pericardium and the fibrous pericardium.

Prevention

There is no way to prevent pericarditis, but a healthy lifestyle with proper nutrition and exercise will help keep the body's immune system strong and more likely to fight off invading microorganisms.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300 or (800) 242-8721. inquire@heart.org. http://www.americanheart.org.

National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

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pericarditis /peri·car·di·tis/ (-kahr-di´tis) inflammation of the pericardium.pericardit´ic

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adhesive pericarditis  a condition due to the presence of dense fibrous tissue between the parietal and visceral layers of the pericardium.

constrictive pericarditis  a chronic form in which a fibrotic, thickened, adherent pericardium restricts diastolic filling and cardiac output, usually resulting from a series of events beginning with fibrin deposition on the pericardial surface followed by fibrotic thickening and scarring and obliteration of the pericardial space.

fibrinous pericarditis , fibrous pericarditis that characterized by a fibrinous exudate, sometimes accompanied by a serous effusion; usually manifested as a pericardial friction rub.

pericarditis obli´terans , obliterating pericarditis adhesive pericarditis that leads to obliteration of the pericardial cavity.

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per·i·car·di·tis (pr-kär-dts)

n.

Inflammation of the pericardium.

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pericarditis

[per′ikärdī′tis]

Etymology: Gk, peri + kardia, heart, itis

inflammation of the pericardium associated with trauma, malignant neoplastic disease, infection, uremia, myocardial infarction, collagen disease, or unknown causes. See also acute nonspecific pericarditis.

observations Two stages are observed if treatment in the first stage does not halt progress of the condition to the extremely grave second stage. The first stage is characterized by fever; substernal chest pain that radiates to the shoulder or neck; dyspnea; a dry, nonproductive cough; a rapid and forcible pulse; a pericardial friction rub; and a muffled heartbeat over the apex. The patient becomes increasingly anxious, tired, and orthopneic. During the second stage a serofibrinous effusion develops within the pericardium, restricting cardiac activity. If the effusion is purulent (caused by bacterial infection), a high fever, sweat, chills, and prostration also occur. The heart sounds become muffled, weak, and distant on auscultation, and a bulge is visible on the chest over the precordial area.

interventions The patient is kept in bed, and the head of the bed is elevated 45 degrees to decrease dyspnea. Hypothermia treatment may be necessary to reduce the body temperature. An antibiotic or antifungal and analgesic may be ordered. Oxygen and parenteral fluids are usually given, vital signs are evaluated, and the chest is auscultated frequently. Pericardiocentesis or pericardiotomy may be performed to remove accumulated fluid or to make a diagnosis.

nursing considerations Emotional support of a patient being treated for pericarditis requires remaining with the person if he or she is anxious and explaining all procedures thoroughly. During recovery, rest periods are planned and the person is urged to avoid fatigue and exposure to upper respiratory infections. The patient is told to report symptoms of recurrence, including fever, chest pain, and dyspnea.

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pericarditis (peˈ·rē·kar·dīˑ·tis),

n an inflammatory condition of the pericardium associated with malignant neoplastic disease, trauma, uremia, infection, collagen disease, or myocardial infarction.

Pericarditis.

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pericarditis (per´ikärdī´tis),

n an inflammation of the pericardium associated with trauma, malignant neoplastic disease, infection, uremia, myocardial infarction, collagen disease, or idiopathic causes.

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pericarditis

inflammation of the pericardium. Initially there is an audible friction rub on auscultation. Later as fluid accumulates there is a muffling of the heart sounds and sometimes a washing machine sound on auscultation. Congestive heart failure develops terminally. Classified according to exudate produced as fibrinous, fibrinohemorrhagic, hemorrhagic, purulent.

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bread-and-butter pericarditis

see bread and butter pericarditis.

constrictive pericarditis

adhesions between the epicardium and pericardium limit the movement of the heart sometimes sufficiently to cause congestive heart failure.

niche pericarditis

see niche pericarditis.

traumatic pericarditis

occurs in cattle and goats, rarely sheep, when a sharp foreign body is swallowed and lodges in the reticulum, subsequently perforating its wall. The perforation may go as far forward as the pericardial sac, especially if the animal is pregnant. The animal dies of a combination of congestive heart failure and toxemia due to the bacterial infection.

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pericarditis

Cardiology Inflammation of the pericardium Etiology Infection–eg, polio, influenza, rubella, adenovirus, coxsackieviruses, TB, rheumatic fever, injury or trauma to chest, esophagus, heart; systemic diseases such as CA, kidney failure, leukemia, AIDS or AIDS related disorders, autoimmune disorders, acute MI, myocarditis, RT to chest, immunosuppressants Clinical Pain due to rubbing of pericardium against heart, pericardial effusion Types Bacterial pericarditis, constrictive pericarditis, post-MI pericarditis DiffDx Restrictive cardiomyopathy. See Bacterial pericarditis, Constrictive pericarditis, Dressler syndrome.