Pericardial Disorders

What are Pericardial Disorders?

The pericardium is a membrane that surrounds your heart. It holds the heart in place and helps it work properly. Both chronic and acute pericarditis can be life-threatening. Many of the symptoms of pericarditis are similar to those of other heart and lung conditions. Problems with the pericardium include:

Acute Pericarditis

Acute pericarditis is an inflammation of the sac. It can be from a virus or other infection, a heart attack, heart surgery, other medical conditions, injuries, and certain medicines.

Cardiac Tamponade

Cardiac tamponade is a serious problem in which the buildup of fluid in the sac causes problems with the function of the heart. It can be from tumors, uremia, or the accumulation in the blood of waste materials that are usually eliminated in the urine, bleeding into the pericardium because of surgery or injury, and bleeding caused by anticoagulants in patients with acute pericarditis.

Chronic Constrictive Pericarditis

Chronic Constrictive Pericarditis is the persistence of pericarditis. This can be life-threatening if left untreated.

Pericardial Effusion

Pericardial effusion is the buildup of fluid in the sac. Your heart may become compressed if the buildup is substantial or occurs quickly, which could result in cardiac tamponade, a potentially fatal medical emergency.

The sooner you are evaluated, the sooner you can receive proper diagnosis and treatment. For example, although the cause of acute chest pain may be pericarditis, the original cause could be a heart attack or a blood clot in the lungs (pulmonary embolus).

What are the symptoms of Pericarditis?

Symptoms of pericardial problems include chest pain, rapid heartbeat, and difficulty breathing. Fever is a common symptom of acute pericarditis. Treatment depends on the cause.

The most common symptoms of acute pericarditis are:

• Chest pain, tightness, or pressure
• Pericardial friction rub or murmur
• Excessive fluid around the heart
• Dull-chest pain
• Low-grade fever

Most symptoms of cardiac tamponade include:

• Rapid heartbeat
• Difficulty breathing
• Severe drop in blood pressure
• Weak pulse
• Decreased heart sounds
• Distended or bulging veins
• Bluish skin color, or cyanosis
• Severe anxiety or panic

Most symptoms of chronic constrictive pericarditis include:

• Fatigue
• Weakness
• Shortness of breath
• Weight loss
• Loss of appetite
• Liver enlargement
• Distended neck veins
• Ascites, or the accumulation of fluid in the abdomen
• Edema, or the accumulation of fluid in the extremities

Chest pain that accompanies pericarditis may be worsened by lying down, coughing, breathing deeply, and sometimes by swallowing.

How are Pericardial Disorders treated?

Medication

The physician may treat acute pericarditis by prescribing medications, including:

• Nonsteroidal anti-inflammatories (NSAIDs), such as aspirin or ibuprofen
• Morphine or codeine
• Antiarrhythmic drugs
• Antibiotics
• Corticosteroids

​Pericardiocentesis (pericardial tap)

To prevent fluid reaccumulation, a needle and catheter are sometimes inserted into the pericardium to remove fluid from the sac around the heart. This procedure relieves pressure on the heart and the catheter may be left in place for several days. The fluid may then be sent to a laboratory for tests to look for signs of infection or cancer. If the fluid re-accumulates, the physician may consider surgery to remove a portion of the pericardium so that fluid drains continuously.

Cardiac Surgery

Removal of the stiffened pericardium in a procedure called pericardiectomy is the only cure for chronic constrictive pericarditis.