percutaneous transluminal coronary angioplasty
(PCTA) See ANGIOPLASTY.
pericarditis INFLAMMATION of the PERICARDIUM,
the membranous sac that surrounds and protects
the HEART. Pericarditis can be acute (comes on sud-
denly) or chronic (intermittent symptoms over a
period of time), the result of an INFECTIONor an
autoimmune disorder such as RHEUMATOID
ARTHRITIS. Infections are usually viral, with the
coxsackie VIRUSand echovirus the most common
culprits, though viral pericarditis may follow
INFLUENZAor accompany AIDS. Bacterial pericardi-
tis is less common and may occur after bacterial
infection elsewhere in the body (such as STREP
THROAT) or as a complication of an OPEN HEART SUR-
GERY. Pericarditis may also develop after HEART
ATTACKas an inflammatory response, typically with
symptoms that begin within five days of the heart
attack. Chronic pericarditis generally results from
inflammatory processes not related to infection.
Certain cancers, notably LEUKEMIA and KAPOSI’S
SARCOMA, can involve the pericardium, causing
ongoing or intermittent symptoms.
Any CHEST PAINthat persists longer than
five minutes, especially pain that radi-
ates into the arm and back, requires
emergency medical evaluation to rule
out HEART ATTACK.The primary symptoms of pericarditis are PAIN
from the chest, usually that radiates to the back or
into the upper arm and shoulder, COUGH, and
shortness of breath. Pain is usually sharp, worse
with BREATHING in or lying down and relieved
when sitting or standing upright. These symptoms
are initially difficult to distinguish from heart
attack, and typically result in emergency medical
evaluation to determine whether heart attack is
taking place. Many people have FEVERwith acute
pericarditis, and upon AUSCULTATION(listening to
the chest with a STETHOSCOPE) the doctor can hear
a characteristic sound called a friction rub. The
pain of pericarditis comes from the pericardium,
not the heart, a result of the pericardium rubbing
against the heart or the LUNGSand chest cavity.
A potentially life-threatening complication of
pericarditis is the rapid accumulation of fluid in
the pericardial space, a filmy envelope in the peri-
cardium’s inner layer that normally contains a
small amount of fluid to lubricate the beating
heart. The fibrous outer pericardium does not
have much ability to stretch to accommodate
increased fluid, so the fluid instead pushes inward
against the heart. The pressure restricts the heart’s
ability to contract to fill with BLOOD, resulting in a
dangerous condition called cardiac tamponade.
BLOOD PRESSUREand HEART RATEdrop perilously in
cardiac tamponade, and the compression can
cause the heart to stop beating entirely. Some
increase in fluid usually occurs with pericarditis,
as that is part of the body’s protective response to
inflammation. When gradual and limited, such
fluid increase does not usually affect the heart’s
function as the pericardium can slowly expand in
response.
The diagnostic path includes ELECTROCARDIO-
GRAM(ECG), which reveals any arrhythmias or
strain on the heart, and ECHOCARDIOGRAMto visual-
ize the heart and its related structures. Echocar-
diogram usually shows the inflammation and any
fluid accumulation, and helps distinguish peri-
carditis from other conditions such as heart attack
or restrictive HEART FAILURE. Additional imaging
procedures may include COMPUTED TOMOGRAPHY
(CT) SCAN or MAGNETIC RESONANCE IMAGING(MRI).
Treatment may include NONSTEROIDAL ANTI-INFLAM-
MATORY DRUGS(NSAIDS) to relieve inflammation and
pain, or CORTICOSTEROID MEDICATIONSif the inflam-
mation is severe. Pericardiocentesis, in which the
doctor uses a long needle and syringe to withdraw
fluid from the pericardium, is necessary when
fluid accumulation pressures the heart. Pericardio-
centesis can determine whether the pericarditis is
bacterial, in which case the doctor administers
ANTIBIOTIC MEDICATIONSas well.
Most people who do not have underlying CAR-
DIOVASCULAR DISEASE(CVD) or other significant sys-
temic conditions make full and complete recovery
within two or three weeks. Pericarditis can com-
plicate cardiovascular disease. Systemic AUTOIM-
MUNE DISORDERSor inflammatory conditions may
result in chronic pericarditis that may require
ongoing anti-inflammatory therapy, usually with
NSAIDs.
See alsoBACTERIA; CARDIOVASCULAR DISEASE PRE-
VENTION; CORONARY ARTERY BYPASS GRAFT (CABG);pericarditis 95