Pericarditis Health Article

Signs and tests

When listening to the heart with a stethoscope, the health care provider can hear a typical sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be crackles in the lungs, decreased breath sounds, or other signs of fluid in the space around the lungs (pleural effusion).

If fluid has accumulated in the pericardial sac, it may show on:

• Chest x-ray
• Echocardiogram
• Chest MRI scan
• Heart MRI or heart CT scan
• Radionuclide scanning

These tests show enlargement of the heart from fluid collection in the pericardium, and signs of inflammation. They may also show scarring and contracture of the pericardium (constrictive pericarditis). Other findings vary depending on the cause of pericarditis.

An ECG is abnormal in 90% of patients with acute pericarditis. ECG changes generally evolve during the disease process, and they may mimic the ECG changes of a heart attack. To rule out heart attack, serial cardiac marker levels (CK -MB and troponin I) may be ordered. Other laboratory tests may include:

• Blood culture
• CBC, may show increased WBC count
• C-reactive protein
• Erythrocyte sedimentation rate (ESR)
• Pericardiocentesis, with chemical analysis and pericardial fluid culture

Treatment

The cause of pericarditis must be identified, if possible.

In most types of pericarditis, it is necessary to treat the pain with analgesics (pain killers). The inflammation of the pericardium is treated with anti-inflammatory drugs(NSAIDS) such as aspirin and ibuprofen. Iin some cases, corticosteroids may be prescribed.

Diuretics may be used to remove excess fluid accumulated in the pericardial sac. If the buildup of pericardial fluid makes the heart function poorly or produces cardiac tamponade, it is necessary to drain the fluid from the sac. This procedure, called pericardiocentesis, may be done using an echocardiography-guided needle or surgically in a minor procedure.

Bacterial pericarditis must be treated with antibiotics. Fungal pericarditis is treated with antifungal agents.

If the pericarditis is chronic, recurrent, or causes constrictive pericarditis, cutting or removing part of the pericardium may be recommended.