Pericardium is a sac of tough fibrous tissue that envelops the heart and the roots of the blood vessels which enter and leave the heart. The pathognomonic physical finding of acute pericarditis is the pericardial friction rub, which is usually auscultated along the lower left sternal border. The electrocardiogram (ECG) is a useful, simple tool that may aid in the diagnosis of acute pericarditis.

Pericarditis can affect people of any age, but most often affects men aged 20 to 50 years old.

Causes

In most cases, why pericarditis occurs is unknown. However, it can result from one or more of these :-

A viral, bacterial or fungal infection

Heart attack

Cancer spreading from a nearby tumor in the lung, breast or the blood

Radiation treatment

Injury or surgery

Pericarditis may develop as a complication of myocardial infarction which is a heart attack. On rare, occasions, pericarditis may develop as a reaction to certain medications.

Symptoms

Symptoms of pericarditis include pain in the centre of the chest and many people believe they are having a heart attack which is worse when taking a deep breath and relieved by sitting forwards; fever; pain in the shoulders and neck; difficulty breathing; cough and fatigue.

Some patients with pericarditis develop fast heart rhythms (tachycardias). Rare patients develop rapid accumulation of fluid in the pericardial sac. This fluid causes compression of the heart muscle chambers, thereby limiting the amount of blood pumped to the rest of the body, and causing shock. Sudden heart failure is a medical emergency that requires immediate care.

Treatment

In most types of pericarditis, it is necessary to treat the pain with analgesics (pain killers). The inflammation of the pericardium is treated with anti-inflammatory drugs such as ibuprofen, corticosteroids may be prescribed. Aspirin is effective and is sometimes prescribed as initial therapy. Usually, one of a group of agents called nonsteroidal anti-inflammatory drugs (NSAIDs) is prescribed: ibuprofen (Advil, Medipren, Motrin, Nuprin, Rufen), indomethacin (Indocin), and naproxen (Aleve, Anaprox, Naprosyn). NSAIDs are usually quite effective in reducing inflammation and eliminating the pain associated with pericarditis.

Another type of medicine called colchicine may be used to treat pericarditis and prevent repeat (recurrent) episodes. If a bacterial infection is causing pericarditis, your doctor will prescribe antibiotics to treat it.

Be sure to report to your doctor any medicines that you are already taking. If you have pericarditis, taking anticoagulant medicines can cause bleeding into the pericardial space (hemorrhagic pericardial effusion).