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What are the symptoms of pericarditis?
Chest pain is the most common symptom of pericarditis.
- Classically, the pain is begins in the center of the chest and radiates to the neck or upper back.
- The pain is sharp and stabbing, but may also be felt as a dull, ache or burning pain.
- The intensity may be mild or very severe and it can come on gradually or suddenly.
- The pain makes it hurt to take a breath.
- Most individuals feel worse when lying flat.
When pericarditis is due to infection, the symptoms tend to arise quickly while inflammation due to chronic diseases is more gradual in onset.
How is pericarditis diagnosed?
History and physical examination
The diagnosis of pericarditis begins with the health care professional taking a history about the pain and its character. The health-care professional will perform a physical examination and ask the patient about associated symptoms. Past medical history is important, since pericarditis can be a complication of a chronic disease or a side effect of medication.
The most common physical finding that helps confirm the diagnosis of pericarditis is a pericardial friction rub. Inflammation prevents the two layers of pericardium from easily sliding against each other with each heartbeat. The inflammation causes a friction noise that can be heard with a stethoscope when listening to the heart. It is better heard when the patient leans forward, which causes the heart to shift to the front of the chest. The rub may not always be present and may come and go from hour to hour.
The electrocardiogram (EKG or ECG) shows electrical activity of the heart. In pericarditis, there are hallmark changes that are seen and can help make the diagnosis. While an abnormal EKG is helpful in making the diagnosis, in the early stages of inflammation, the EKG may be normal. In most cases of uncomplicated pericarditis, a chest X-ray is usually normal. However, if fluid accumulates in the pericardial sac, the heart can appear larger on the X-ray.
A sound wave test of the heart (an echocardiogram or ultrasound of the heart) is very helpful in detecting and quantifying the fluid in pericarditis. The purpose of the test is to detect an accumulation of fluid in the pericardial sac, called an effusion. Although in many mild cases of acute pericarditis, there is no pericardial fluid seen with echocardiography. A variety of blood tests may be ordered depending upon the clinical situation.
Pericardiocentesis (please see below), is a procedure using a needle, is used to draw fluid out of the pericardial sac. It may be done to detect bacterial infection. This procedure can also be used to treat dangerous, severe pericarditis called pericardial tamponade.