Pericarditis is an inflammation of the pericardium, the fibroserous sac that envelops, supports, and protects the heart. It occurs in both acute and chronic forms. Acute pericarditis can be fibrinous or effusive, with purulent, serous, or hemorrhagic exudate; chronic constrictive pericarditis is characterized by dense fibrous pericardial thickening. The prognosis depends on the underlying cause but is generally good in acute pericarditis, unless constriction occurs.
Common causes of this disease include:
bacterial, fungal, or viral infection (infectious pericarditis)
neoplasms (primary, or metastases from lungs, breasts, or other organs)
high-dose radiation to the chest
hypersensitivity, systemic disease, or autoimmune disease, such as acute rheumatic fever (most common cause of pericarditis in children), systemic lupus erythematosus, acquired immuno-deficiency syndrome–related disorders, or rheumatoid arthritis
postcardiac injury, such as myocardial infarction (MI), which later causes an autoimmune reaction (Dressler’s syndrome) in the pericardium; trauma
or surgery that leaves the pericardium intact but causes blood to leak into the pericardial cavity
drugs, such as hydralazine, nydrazid, phenytoin, and procainamide
idiopathic factors (most common in acute pericarditis).
Less common causes include aortic aneurysm with pericardial leakage and myxedema with cholesterol deposits in the pericardium.
Signs and symptoms
Clinical features vary in the acute and chronic forms.
In acute pericarditis, a sharp and commonly sudden pain usually starts over the sternum and radiates to the neck, shoulders, back, and arms. However, unlike the pain of an MI, pericardial pain is often pleuritic, increasing with deep inspiration and decreasing when the patient sits up and leans forward, pulling the heart away from the diaphragmatic pleurae of the lungs.
Pericardial effusion, the major complication of acute pericarditis, may produce the effects of heart failure—such as dyspnea, orthopnea, and tachycardia—as well as ill-defined substernal chest pain and a feeling of fullness in the chest.