Usually pericarditis occurs suddenly (acute) but less commonly can be more indolent and persistent (chronic). Sometimes analysis of the fluid removed helps determine the cause. This is done with a pericardiocentesis where a needle is inserted through the skin of the lower chest and through the pericardium so that fluid can be drained to relieve the pressure around the heart. Pericardial tamponade and sometimes moderate to large pericardial effusions (even without tamponade) require the pericardial effusion to be drained, sometimes very urgently. This can lead to a life-threatening condition known as pericardial tamponade. ![]() However, pericardial effusions can grow and if this occurs rapidly or leads to a large pericardial effusion, a significant amount of pressure from the fluid build-up can cause the heart to not be able to fill or beat properly. ![]() Most cases of pericarditis cause minimal fluid build-up and can be monitored with an echocardiogram and will gradually resolve. When the pericardium is inflammed, it can leak inflammatory fluid which can build up between the pericardial layers (percardial effusion). The pericardium normally has two layers, an inner or visceral pericardium lining the heart and an outer parietal pericardium with a very small amount of fluid between the pericardial layers to help prevent friction between the two surfaces and to help cushion the heart. Most patients recover in two to four weeks. In more severe acute cases, steroids sometimes are added. While antibiotics infrequently are required for non-viral infectious causes, most cases are treated with NSAID’s (non-steroidal anti-inflammatory drugs such as indomethacin, ibuprofen or naproxen) and sometimes cochicine is added to help decrease the pain and inflammation. Infrequently, arrhythmias can occur such as atrial fibrillation. Pericarditis can cause shortness of breath and it can be accompanied by fever and fatigue. Trauma, tumors, cancer and radiation to the chest are also less common causes. In up to half of cases it occurs for no discernable cause (idiopathic) but pericarditis can be related to auto-immune (or immunological) inflammatory conditions such as systemic lupus erythematosus (SLE) and rheumatoid arthritis or be caused by certain medications. It can occur due to general inflammation after a heart attack, typically larger heart attacks (Dressler’s syndrome) or after open-heart or chest surgery (post-pericardiotomy syndrome). Pericarditis can be caused by an infection, most commonly viral infections although rarely bacterial or fungal infections can be the cause (the most common cause outside of the US is tuberculosis). The pain may radiate to the shoulder, neck or back and is typically sharp and “stabbing.” The chest pain may feel like pain from a heart attack and, thus, if you have chest pain, you should call 9-1-1 right away. The chest pain is caused by the inflamed pericardium rubbing against the heart. Pericarditis typically causes chest pain, most commonly worsening with taking in a deep breath (pleuritic chest pain), sometimes worsening when lying down and often relieved by sitting up and leaning forward. In the medical world, the suffix “-itis” at the end of a medical term refers to inflammation. “Peri” means surrounding and “cardium” means the heart. It can be a successful option for people who have pericarditis that goes away and comes back or who have end-stage constrictive pericarditis, which develops when the pericardium becomes thickened and scarred.Pericarditis (perikar’ DI-tis) is a condition in which the fibrous sac-like covering around the heart (pericardium) becomes inflamed. This treatment is only recommended when medicine or other treatments have not worked. Pericardiectomy is a surgery to remove part or most of the pericardium.Risks of the procedure are rare but include bleeding, infection, or damage to the heart. Pericardiocentesis is a procedure that removes extra fluid in the pericardium (pericardial effusion) with a thin needle.Antibiotics can treat a bacterial infection if that is the cause.Intravenous immunoglobulin (IVIG) helps control the body’s immune and. ![]() Side effects can include weight gain and increased risk of infection. With pericarditis, corticosteroids are used only in people who are not responding to or cannot take NSAIDs. Corticosteroids like prednisone lower the activity of the body’s immune system.Side effects are mainly gastrointestinal and include abdominal pain, nausea, vomiting, and diarrhea. Medicines to relieve pain and reduce inflammation include colchicine, aspirin, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.The goal of most treatments is to lessen pain, lower inflammation of the pericardium, and fix pericardial Treatment can vary from person to person depending on the cause and how severe it is.
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