| Pericarditis is an inflammation of the sac-like structure that surrounds and confines the heart (pericardium or pericardial sac). Acute inflammation of the pericardium may be due to an infectious process (viral) or systemic diseases, autoimmune syndromes, uremia, tumors, radiation therapy, drug toxicity, tuberculosis, nosocomial infections (acquired in the hospital), or bleeding into the pericardium (hemopericardium). No cause is found in 88% of individuals (idiopathic) (Jouriles).
Acute pericarditis may also be an early consequence of heart attacks. About 20% of those who have heart attacks will develop pericarditis (Dressler's syndrome) (Jouriles). In rare occasions, acute pericarditis recurs chronically.Risk: Increasing age and male sex are risk factors for acute pericarditis. Incidence and Prevalence: Acute pericarditis accounts for 1 out of 1000 hospital admissions (Gentlesk). Autopsy studies indicate an incidence of 2% to 6% (Jouriles). |
Source: Medical Disability Advisor
| History: In most individuals, chest pain is usually present and can be severe. The individual may mistake it for a heart attack. The pain is sharp and worsens when inhaling or coughing. Others may have a steady pain, originating in the center of the chest, and radiating to the arms. In almost all cases, pain is relieved markedly when the individual sits up and leans forward. Pain is usually absent in pericarditis caused by chronic kidney failure (uremic pericarditis), cancer, or after radiation therapy. Physical exam: Fever may be present when pericarditis is caused by an infection. The most important physical sign is scratching or squeaking heart sounds (pericardial friction rub) heard with a stethoscope that change with different positions. Individuals may also have a rapid heartbeat (tachycardia), rapid breathing (tachypnea), low blood pressure (hypotension), enlarged jugular neck veins (jugular venous distention) and muffled or distant heart sounds. Tests: Usual tests include blood work such as a complete blood count (CBC), tests to assess for inflammation (erythrocyte sedimentation rate [ESR] and C-reactive protein), autoimmune disorders, and cardiac enzyme tests for myocardial infarction (MI). Blood cultures may be needed to assess for systemic infection. Additional tests include physical and/or chemical examination of urine (urinalysis), chest x-rays, electrocardiogram, echocardiogram, and CT or MRI. Endomyocardial biopsy may be done for pericarditis thought to be associated with cancer. |
Source: Medical Disability Advisor
| Treatment is focused on relieving the acute symptoms and treating any underlying cause. The inflammation is often treated with anti-inflammatory agents such as aspirin, indomethacin, or other non-steroidal anti-inflammatory agents (NSAIDs). Corticosteroids may be used if pain and inflammation is unresponsive to the standard anti-inflammatory drugs.
If the inflammatory condition is secondary to bacterial infection or tuberculosis, antibiotics or antituberculous drugs are added as appropriate. If the source of inflammation is drug induced, then the offending drug should be discontinued.
Sometimes, fluid accumulates around the heart restricting its movement (cardiac tamponade). It may be necessary to use a needle to remove fluids and relieve excess pressure (pericardiocentesis). This procedure is usually reserved for individuals who have large accumulations of fluid and associated shock (severe cardiac dysfunction).
In persistent cases of fluid accumulation, typically with tumors or kidney disease, it may be necessary to surgically remove part of the pericardium (pericardiectomy) to allow continuous drainage. |
Source: Medical Disability Advisor
| Pericarditis may be life-threatening if left untreated. However, most cases of acute pericarditis that are treated, heal promptly. There may be recurrences in the first few weeks or months. Prognosis is also dependent on the cause. Viral or idiopathic causes usually resolve quickly. Infectious, tuberculous, and cancer related pericarditis have worse outcomes.
Surgical removal of the pericardium (pericardiectomy) to treat a chronically stiffened pericardium (chronic constrictive pericarditis) has a mortality rate of 46% in one study (Gentlesk) when there is associated severe heart failure. |
Source: Medical Disability Advisor
| Rehabilitation for acute pericarditis includes treatment to relieve symptoms of pain as well as exercises to improve strength and endurance. The greatest benefit to the heart occurs as the muscles improve efficiency in oxygen use reducing the need for the heart to pump as much blood. While such exercise may not improve the condition of the heart itself, the increased fitness level reduces the total workload of the heart.
Initially and when appropriate, physical therapists may choose to use passive modalities until acute symptoms have subsided. Once acute symptoms have resolved, a prescribed exercise program will begin. A physical therapist knowledgeable in cardiac rehabilitation will design a safe individualized exercise program. The therapist keeps a daily log of the individual's blood pressure, heart rate, and cardiac rhythm. Individuals are encouraged to resume normal activities gradually. As endurance improves, aerobic routines are added such as running, brisk walking, cycling, or swimming to increase the strength and efficiency of the heart muscle. The goal is for the individual to resume their daily routine with an eventual return to work.
The physical therapist will also watch closely for any shortness of breath, rapid heartbeat, coughing up blood, or unexplained excessive weight loss. Because of the various degrees and effects of acute pericarditis, modifications may be needed for those individuals who are taking various medications or are experiencing other conditions resulting from the pericarditis. |
Source: Medical Disability Advisor
| Acute pericarditis may be accompanied by fluid buildup (effusion) in the pericardial sac. When the fluid accumulates, it can constrict the heart, obstructing blood flow into the chambers of the heart, and reduce blood flow out of the heart (cardiac tamponade). Tamponade may occur within minutes after cardiac trauma or rupture causing shock and occasionally death, but it usually develops over time. Complications associated with pericardiocentesis include accidental puncture of vessels in the heart, lung, and liver.
When acute pericarditis recurs chronically, it may lead to stiffening of the pericardial sac that can impair heart movement and result in heart failure (chronic constrictive pericarditis).
If pericardiectomy is required, complications from surgery can include medication reaction, infection, and slow wound healing. |
Source: Medical Disability Advisor
| Individuals with strenuous jobs may need to perform sedentary or lighter work until strength and endurance return. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual recently had a respiratory infection or any other infections?
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Does individual have an autoimmune disorder?
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Does individual have a history of tumors?
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Has individual undergone recent radiation therapy?
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Has individual recently had a heart attack (myocardial infarction)?
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Does individual complain of severe chest pain? Is the pain worsened by breathing in or coughing and relieved markedly by sitting up and leaning forward?
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Is fever present?
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Does the physician hear scratching or squeaking heart sounds (pericardial friction rub) with a stethoscope (auscultation)?
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Were a complete blood count (CBC), blood chemistries and blood work to assess for causes done? Were chest x-rays, electrocardiogram (ECG), echocardiogram, CT or MRI performed? If cancer was suspected was endomyocardial biopsy done?
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Was the diagnosis of pericarditis confirmed?
Regarding treatment:
- Were nonsteroidal anti-inflammatory (NSAIDs) administered? If pain and inflammation did not respond to the anti-inflammatory drugs, were corticosteroids administered?
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If the condition is secondary to bacterial infection or tuberculosis, were antibiotic or antituberculous drugs added?
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Has individual been compliant with all medication regimens?
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Did fluid accumulate around the heart restricting its movement (cardiac tamponade)? Was it necessary to remove the fluid using a needle (pericardiocentesis)? If fluid accumulates persistently, is surgical removal of part of the pericardium (pericardiectomy) required to allow for continuous drainage?
Regarding prognosis:
- Was pericarditis treated promptly? If not, is individual in a life-threatening situation?
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Is this an initial diagnosis or a recurrence?
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Does individual have any underlying heart or other conditions that could prolong recovery?
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Did complications from pericardiectomy or pericardiocentesis occur such as accidental puncture of cardiac vessels, the lung, or liver? If so, what is the treatment plan for these complications and expected outcome after treatment?
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Source: Medical Disability Advisor
| Gentlesk, Philip J., and John McCabe. "Pericarditis, Acute." eMedicine. Eds. Hanumant Deshmukh, et al. 5 Mar. 2004. Medscape. 31 Oct. 2004 <http://emedicine.com/med/topic1781.htm>.Jouriles, N. "Pericardial Disease (Pericarditis)." Rosen's Emergency Medicine: Concepts and Clinical Practice. Eds. J. A. Marx, et al. 5th ed. Philadelphia: Elsevier, Inc., 2004. 1130-1138. MD Consult. Elsevier, Inc. 31 Oct. 2004 <http://home.mdconsult.com/das/book/39734865-2/view/999?sid=289230156>. |
Source: Medical Disability Advisor
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