Chronic Pericarditis

WHAT YOU SHOULD KNOW:

• Chronic pericarditis is an inflammation (swelling) of the pericardium lasting for more than three months. The pericardium is the sac around your heart and its large blood vessels. It holds your heart in the center of your chest and protects it from infections in your body. A small amount of clear fluid between the heart and the sac keeps them from rubbing against each other. Chronic pericarditis may start with symptoms that appear suddenly and worsen quickly, and your condition may have gotten worse over time. Damage to your pericardium from germs, injuries, and certain medicines or procedures may cause your condition. Cancer, kidney failure, tuberculosis, or pregnancy may also cause chronic pericarditis. Your symptoms may come and go and may include fatigue, fever, trouble breathing, or chest pain.
  
  
• Caregivers may do an electrocardiogram (ECG), echocardiogram, blood tests, and imaging tests to learn about your condition. A sample of fluid or heart tissue may be collected and tested. Medicine may be given to decrease pain and swelling. Antibiotic medicine will help treat infection. Your caregiver may also do procedures to remove extra fluid and damaged areas in the sac. This can decrease or take away your symptoms and help your heart beat correctly. Treatment can prevent more and serious problems with your heart from developing.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

Medicines used to treat chronic pericarditis may cause an upset stomach and allergic reaction. Your skin may be itchy, red, and swollen. You may have infection or bleeding when the fluid in the sac is removed. Even after treatment, your condition may come back. If you are not treated, your symptoms may stay for a long time and scar your heart. The fluid may stop your heart from beating correctly. When your heart is scarred and not beating well, your body organs may not get enough blood and oxygen. This can damage your organs and even cause death. Call your caregiver if you have questions about your condition, medicines, or care.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Activity: You may need to rest and avoid physical activity. Ask your caregiver what you are allowed to do while in the hospital.

Medicines:

• Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
  
  
• Nonsteroidal anti-inflammatory medicine: These medicines are also called NSAIDs. They help decrease pain, inflammation (swelling), and a high body temperature (fever).
  
  
• Proton pump inhibitors: These are used to help prevent problems that can happen if you use NSAIDs, such as an upset stomach.
  
  
• Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.

Tests:

• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in the heart. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded.
  
  
• Echocardiogram: This test is also called an echo. It uses sound waves to show pictures of the size and shape of your heart, and how your heart moves when it is beating. An echo can also see fluid around the heart and problems with your heart valves.
  
  
• Imaging tests: Tests such as chest x-rays, computerized tomography scan (CT scan), or magnetic resonance imaging (MRI) take pictures of your chest. This shows your caregiver fluid around the heart.
  
  
• Pericardial biopsy: This procedure is used to take a small piece of your heart sac. Your caregiver may make an incision (cut) through your chest and slice a small piece of the sac. It is then sent to a lab for tests.
  
  
• Pericardiocentesis: This procedure uses a long needle to take a fluid sample from the sac. The sample is sent to a lab for tests. This procedure can also remove extra fluid and decrease or take away your symptoms.
  
  
• Transesophageal echocardiogram:
  
  
  • A transesophageal echocardiogram (TEE) is a type of ultrasound that shows pictures of the size and shape of your heart. It also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen. You may need a TEE if your heart does not show up very well in a regular echocardiogram. You may also need a TEE to check for certain problems such as blood clots or infection inside the heart.
    
    
  • You will be given medicine to relax you during a TEE. Caregivers put a tube in your mouth that is moved down into your esophagus (food pipe). The tube has a small ultrasound sensor on the end. Since your esophagus is right next to your heart, your caregiver can see your heart clearly.

Treatment options: You may need any of the following procedures:

• Balloon pericardiotomy: This uses a small balloon to make a hole in your heart sac to let out fluid.
  
  
• Pericardial biopsy: A piece of your heart sac is taken to make a small hole and drain fluid from the sac.
  
  
• Pericardiectomy: All or a part of a very badly scarred heart sac is removed. Your caregiver makes an incision through your chest and removes or repairs areas that are damaged.
  
  
• Pericardiocentesis: Extra fluid in the sac is removed to help your heart beat better. A long thin needle is inserted in your chest, up to the space between your heart and the sac. Fluid is removed through the needle.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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