Pericarditis is a disorder caused by inflammation of the pericardium, which is the sac-like covering around the heart.

Pericarditis is usually a complication of viral infections, most commonly echovirus or coxsackie virus. Less frequently, it is caused by influenza or HIV infection. Infections with bacteria can lead to bacterial pericarditis (also called purulent pericarditis). Some fungal infections can also produce pericarditis.

In addition, pericarditis can be associated with systemic diseases such as autoimmune disorders, rheumatic fever, tuberculosis, cancer, leukemia, kidney failure, HIV infection, AIDS, and hypothyroidism.

Heart attack (see post-MI pericarditis) and myocarditis can cause pericarditis, as can radiation therapy to the chest and medications that suppress the immune system. Pericarditis can also be caused by injury (including surgery) or trauma to the chest, esophagus, or heart.

Quite often the cause of pericarditis remains unknown, in which case it is called idiopathic pericarditis.

Pericarditis most often affects men aged 20-50, usually following respiratory infections. In children, it is most commonly caused by adenovirus or coxsackie virus.

• Chest pain, caused by the inflamed pericardium rubbing against the heart.
  • Usually relieved by sitting up and leaning forward
  • Pleuritis type: a sharp, stabbing pain
  • May radiate to the neck, shoulder, back or abdomen
  • Often increases with deep breathing and lying flat, and may increase with coughing and swallowing
• Breathing difficulty when lying down
• Need to bend over or hold the chest while breathing
• Dry cough
• Ankle, feet and leg swelling (occasionally)
• Anxiety
• Fatigue
• Fever

When listening to the heart with a stethoscope, the health care provider can hear a typical sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be crackles in the lungs, decreased breath sounds, or other signs of fluid in the space around the lungs (pleural effusion).

If fluid has accumulated in the pericardial sac, it may show on:

• Chest x-ray
• Echocardiogram
• Chest MRI scan
• Heart MRI or heart CT scan
• Radionuclide scanning

These tests show enlargement of the heart from fluid collection in the pericardium, and signs of inflammation. They may also show scarring and contracture of the pericardium (constrictive pericarditis). Other findings vary depending on the cause of pericarditis.

An ECG is abnormal in 90% of patients with acute pericarditis. ECG changes generally evolve during the disease process, and they may mimic the ECG changes of a heart attack. To rule out heart attack, serial cardiac marker levels (CK -MB and troponin I) may be ordered. Other laboratory tests may include:

• Blood culture
• CBC, may show increased WBC count
• C-reactive protein
• Erythrocyte sedimentation rate (ESR)
• Pericardiocentesis, with chemical analysis and pericardial fluid culture