Chronic Pericarditis

GENERAL INFORMATION:

What is chronic pericarditis? Chronic pericarditis is an inflammation (swelling) of the pericardium lasting for more than three months. The pericardium is a sac that surrounds your heart and its large blood vessels. It holds your heart in the center of the 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. This fluid may increase in amount and have other materials, such as pus, during this condition.

What causes chronic pericarditis? Chronic pericarditis may start as an acute condition, where the symptoms appear suddenly and worsen quickly. In some cases, the cause is unknown. Your condition may have gotten worse over time. Pericarditis may be caused by any of the following:

• Damage to the sac: Injuries or accidents, such as a hard blow to the chest, may damage the sac.
  
  
• Germs: Germs, such as viruses and bacteria, may cause this condition. Infection in other areas of the body may also spread and reach the sac.
  
  
• HIV infection: When you have human immunodeficiency virus (HIV), your immune system is weak and cannot fight germs. You are at greater risk for getting infections.
  
  
• Medicine: Medicines such as those used to treat cancer and infection.
  
  
• Procedures: Procedures such as a radiation therapy on the chest, or hemodialysis for kidney failure.
  
  
• Kidney failure: Fluid and chemicals may build up in your body and around your heart when your kidneys fail.
  
  
• Tuberculosis: This is a condition where a bacteria (germ) causes infection (swelling) in your lungs. These germs may spread and reach the heart sac.
  
  
• Other conditions: Autoimmune diseases, cancer, or a heart attack may damage or increase the amount of fluid in the sac. If you are pregnant, your growing baby may push on your heart and cause problems with your heart.

What are the signs and symptoms of chronic pericarditis? Your signs and symptoms may have been coming and going for a long time. You may have any of the following:

• Fatigue (feeling very tired most of the time) and getting tired very easily.
  
  
• Fever.
  
  
• Pain in your chest that becomes worse when lying down.
  
  
• Palpitations (fast, strong heartbeats).
  
  
• Trouble breathing.

How is chronic pericarditis diagnosed? Your caregiver will examine you and ask about past medical problems. He will listen very carefully to your heart and check for problems. You may also have any of the following 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. Caregivers will look closely for certain problems or changes in how your heart is working.
  
  
• Blood tests: You may need blood taken for tests. It can give your caregivers more information about your health condition.
  
  
• 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 or 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 caregivers fluid around your 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.

How is chronic pericarditis treated? Your caregiver will have to treat medical conditions causing your condition or making it worse. You may have any of the following:

• 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 unwanted side effects from taking NSAIDs, such as an upset stomach.
    
    
  • Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.
  
  
• 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 (cut) 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. A certain amount of fluid is removed through the needle.

Where can I get more information?

• American Heart Association National Center
  7272 Greenville Avenue
  Dallas, TX 75231-4596
  Phone: 1-800-242-8721
  Web Address: http://www.americanheart.org
  

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.

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