The pericardial sac that surrounds the heart has two layers. Normally, this sac contains some lubricating fluid. When the sac is inflamed, the two layers will rub against each other, causing chest pain.

The condition can clear up without treatment, or it can last weeks to months. The chest pain can range from dull to stabbing and migrate to the neck and left shoulder. Some people have difficulty differentiating between pericarditis and chest pain from a heart attack.

Causes of pericarditis

Most often, physicians cannot determine the cause of pericarditis. In some cases, a viral infection may be the cause. Other causes include a traumatic chest or heart injury; some medications; conditions including AIDS, cancer, tuberculosis and kidney failure; and inflammatory conditions including rheumatoid arthritis and lupus.

Some people develop pericarditis after a heart attack or heart surgery. This type of pericarditis is called Dressler’s syndrome.

Symptoms of pericarditis

Symptoms can include chest pain. Other symptoms include difficulty catching your breath when lying down, a low fever and fatigue. Pericarditis can result in damage to the pericardium, causing rigidity that prevents the heart from proper function. This is called constrictive pericarditis.

How Ohio State diagnoses pericarditis

Using a stethoscope, a physician may be able to hear the layers of the pericardium rubbing together. The physician also may order tests to check for a heart attack and infection. The primary diagnostic tests for pericarditis include:

• Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine.
• Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves.
• Electrocardiogram (EKG/ECG) – A test that records the electrical activity of the heart.
• CT scan (computed tomography scan, also called CAT scan) – An imaging procedure that uses X-rays and computer technology to produce cross-sectional, detailed images of the body, including bones, muscles, fat and organs.
• Cardiac MRI (cardiac magnetic resonance imaging or CMR) – A noninvasive, sophisticated imaging procedure that uses large magnets and a computer to produce detailed images of the structure and function of the heart while it is beating.

How Ohio State treats pericarditis

Medication

Physicians may prescribe medication to reduce pain and inflammation from pericarditis. Cases that are caused by bacterial infection will require antibiotic treatment. If symptoms persist, they may require treatment with corticosteroids and a medication called colchicine.

Pericarditis typically lasts for a few weeks. Recurring cases are possible.

Surgery and other procedures

Cardiac tamponade is a serious complication of pericarditis. It is treated with pericardiocentesis. In this procedure, a cardiologist inserts a needle or small tube (catheter) to remove excess fluid from the pericardium.

Constrictive pericarditis is another dangerous complication of pericarditis. Pericardiectomy is the surgical procedure that may be required to remove rigid areas of the pericardium.