The pericardium is a container made of two layers of membrane that surrounds the heart. These layers are separated by a plasma-based fluid around the heart that prevents them from rubbing together. The pericardium keeps the heart in its place and maintains pumping efficiency by ensuring that the heart does not expand too much.
Pericarditis is an inflammation of the pericardium that often causes discomfort due to friction between layers of the membrane. The high density of nerves in the pericardium is one reason why pericarditis causes such sharp pain. Although most cases clear up with medications, some conditions may be chronic, and there is always a risk of other complications. As usual, it’s best to consult your doctor or cardiologist and monitor your symptoms.
Symptoms of Pericardium Disease
You may notice an attack of acute pericarditis if you experience very sharp, severe chest pains. The pain associated with pericardial disease usually doesn’t remain localized, either; it can spread to your arms, neck or shoulder.
The pain also worsens when you change positions. Lying down is particularly painful. You may feel a slight easing of the pain if you sit up and lean forward.
Pericardial Effusion Symptoms
Another common form of pericardial disease is called pericardial effusion, which means that too much fluid around the heart accumulates in the sacs surrounding your heart. Sometimes, fluid build-up can occur as a result of an injury or chest trauma, so it’s not directly related to pericardium disease, although the symptoms are the same.
Whether it’s related to disease, infection or accident, pericardial effusion leads to pressure on your heart that directly affects your heart’s functioning. It very often constitutes a medical emergency that requires immediate cardiology care because it can lead to death. Seek immediate cardiovascular doctor attention if you feel:
- Orthopnea, having a difficult time breathing when you lie down
- Dyspnea, difficulty breathing or shortness of breath
- A fullness in your chest
- Pain on the left side of your chest or just behind your breastbone
- Lightheadedness or shock
- Any change in mental status
- A blue tinge to your skin or your lips
Causes May Prove Elusive
There are many possible causes of pericarditis, and they are often difficult to determine. Most commonly, when pericarditis is detected in a patient who also has a respiratory infection or another virus, it’s assumed that the virus is the cause.
Other than viral causes, most cases of pericarditis are described as idiopathic, meaning that the causes are unknown. But since even most acute cases clear up with medication or on their own, the cardiology treatment goal is to manage pain and reduce inflammation. Often, anti-inflammatories effectively treat this type pericarditis.
In some cases, pericarditis is caused by tuberculosis, pneumonia, Hodgkin’s lymphoma or breast carcinoma. Normally, a thorough exam can reveal whether the pericarditis is caused by a dangerous underlying condition. Extensive testing by cardiovascular doctor or cardiologist is worthwhile only if severe symptoms lead to the suspicion that another disease is involved. In some tests, fluid around the heart from within the pericardium is sampled.
Pericarditis can be caused by an injury such as a heavy blow to the chest. It can also be a response to recent heart surgery, heart attack or radiation treatment. Again, cardiovascular doctors suggest that the pericarditis treatment goal is often pain management unless other severe symptoms present themselves.
Although it is normally benign, pericarditis can, in some cases, can become recurrent, persistent, or can cause complications. It’s always good to know about risk factors even if they are unlikely. For example:
- Constrictive pericarditis develops when a patient has pericarditis so often or for so long that scarring occurs in the pericardium. As a result, the pericardium can harden, restricting the heart’s ability to function. In serious cases, the hardened pericardium needs to be surgically removed.
- Cardiac tamponade happens when the pericardium fills with fluid around the heart that severely impairs heart function. This condition is a medical emergency that requires immediate drainage of fluid around the heart with a catheter followed by other treatment. In some cases, the pericardium can be surgically altered so that it drains more effectively.
Testing for Pericarditis
The vast majority of pericarditis cases are essentially just uncomfortable. Since it can be difficult to determine causes, your best bet is to stay in good health and have regular visits with a physician and/or a heart specialist.
The most common symptoms of pericarditis are chest pain, shortness of breath, sense of weakness, heart palpitations and fever. Since these can often overlap with other heart issues, it’s best to see your doctor immediately if you experience them. Various tests can indicate that you have pericarditis:
- Electrocardiogram/EKG is a test that uses electrodes to track your heart’s electrical activity. Distinct changes in the rhythm of electrical activity can be a sign of pericarditis.
- Echocardiogram is a technique that uses sound waves to create a live image of your heart. This test can also evaluate you for complications from pericarditis, since fluid around the heart build up or hardening of the pericardium will be evident.
- Cardiac MRI uses magnetic resonance imaging to show cross sections of your heart. This method reveals the inflammation that’s typical of pericarditis.
- Blood tests can help determine the nature of the infection and maybe even the underlying cause of the pericarditis.
Pericarditis Treatment Options
Unless serious complications like cardiac tamponade or constrictive pericarditis arise, most doctors use medication, such as specific anti-inflammatories, to treat pericarditis and pericardial effusion. Depending on the underlying cause of the symptoms (if any), typical pericarditis treatment medications may include:
- NSAIDs (such as ibuprofen)
While pericarditis treatment medications usually lead to a full recovery, the only treatment for chronic constrictive pericarditis is a surgery called pericardiectomy, during which your doctor removes the damaged or diseased pericardium.
If you have pericardial disease, your cardiologist NYC at Manhattan Cardiovascular Associates will probably suggest that you rest and avoid physical exertion for a period of time. There are also medications that can help reduce the likelihood of a recurrence. For a complete evaluation and discussion, schedule an appointment with your New York City cardiologist.
Dr. Michael Ghalchi, Cardiologist (Heart Doctor in NYC)
New York, NY10010
(Between Madison Ave & Park Ave)
☎ (212) 686-0066