
The pericardium is a thin, two-layered, fluid-filled sac that covers the outer surface of the heart. It shields the heart from infection or malignancy and contains the heart in the chest wall. It also prevents the heart from over-expanding when blood volume increases, which keeps the heart functioning efficiently.
Pericarditis is an inflammation of the pericardium. Pericarditis is usually acute – it develops suddenly and may last up to several months. If you could see and touch it, the membrane around the heart would look red and swollen, like the skin around a cut that becomes inflamed. Sometimes excess fluid develops in the space between the pericardial layers and causes a pericardial effusion (buildup of excess fluid around the heart).
If you have acute pericarditis, the most common symptom is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. However, some people with acute pericarditis describe their chest pain as dull, achy or pressure-like instead, and of varying intensity.
The pain of acute pericarditis may travel into your left shoulder and neck. It often intensifies when you lie down or inhale deeply. Coughing, taking a deep breath or swallowing food also may make the pain worse. Sitting up and leaning forward can often ease the pain. At times, it may be difficult to distinguish pericardial pain from the pain that occurs with a heart attack.
Chronic pericarditis is usually associated with chronic inflammation and may result in fluid around the heart (pericardial effusion). The most common symptom of chronic pericarditis is chest pain.
Depending on the type, signs and symptoms of pericarditis may include some or all of the following:
- Sharp, piercing chest pain over the center or left side of your chest
- Shortness of breath when reclining
- Low-grade fever
- An overall sense of weakness, fatigue or feeling sick
- Dry cough
- Abdominal or leg swelling
Many of the symptoms of pericarditis are similar to those of other heart and lung conditions. The sooner you are evaluated, the sooner you can receive proper diagnosis and treatment. For example, although the cause of acute chest pain may be pericarditis, the original cause could be a heart attack or a blood clot of the lungs (pulmonary embolus).
In some people, pericarditis can cause swelling of the feet, legs or ankles. This swelling may be a symptom of constrictive pericarditis, a serious type of pericarditis. In constrictive pericarditis, the patient’s pericardium hardens and/or thickens, preventing the heart muscle from expanding and affecting the function of the heart. The heart may be compressed by the constrictive process, which may cause blood to back up into the lungs, abdomen and legs, as well as cause the swelling.
There are many causes of pericarditis, but it is often a complication of a viral infection (viral pericarditis) – usually a gastrointestinal virus, or rarely the flu virus or AIDS. It may also be caused by a bacterial infection (bacterial pericarditis), fungal infection (fungal pericarditis) or parasitic infection (parasitic pericarditis).
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Certain autoimmune diseases, such as lupus, rheumatoid arthritis and scleroderma, also can cause pericarditis. Additional causes of pericarditis include injury to the chest such as after a car accident (traumatic pericarditis), other health problems such as kidney failure (uremic pericarditis), tumors, genetic diseases such as Familial Mediterranean Fever (FMF), or rarely, medications that suppress the immune system.