Pericarditis (cont.)
What is the treatment for pericarditis?
Medicines that reduce inflammation are the primary treatment for pericarditis.
Nonsteroidal anti-inflammatory drugs, such as ibuprofen,
are used to decrease the inflammation and fluid accumulation in the pericardial
sac. Occasionally, a short course of narcotic pain medication [codeine,
hydrocodone (Vicodin) or oxycodone
(OxyContin, Roxicodone)] will be needed. In recurrent cases, especially in immunologically-mediated causes, corticosteroids are often very effective.
Treatment of the underlying cause of pericarditis is essential and will be based on the disease process.
Pericardiocentesis, a procedure where a thin needle is inserted through the chest wall into the pericardial sac, may be considered if too much fluid is present (see cardiac tamponade below), or to aid in establishing the cause of the pericarditis (for
example, infection, cancer, etc.) by analyzing the fluid that is removed.
Pericardotomy (cutting a hole in the pericardial sac) or pericardectomy (removing the sac completely) may be needed for recurrent pericarditis of scarring within the pericardial sac.
What are the complications of pericarditis?
Cardiac tamponade
If there is enough fluid in the pericardia sac, there may be enough pressure on the outside of the heart to prevent it from beating adequately to push blood to the body and lungs. The pressure within the sac itself needs to be higher than the pressure within the heart chambers, but symptoms gradually progress as the heart function is compromised. This can be a true medical emergency.
The symptoms tend to be nonspecific but can include shortness of breath and difficulty with exercise or doing daily activities. Additional complaints may be due to the illness or disease that caused the effusion to accumulate in the first place.
Upon physical examination the following signs may be present:
- blood pressure may be low;
- veins in the neck can dilate (jugular venous distention);
- fluid can accumulate in parts of the body that are below the heart due to gravity (edema);
- heart sounds can be muffled because the fluid in the pericardial sac blocks normal heart sounds from being heard with a stethoscope;
- lung examination may reveal fluid back up as well.
Testing likely will include an urgent EKG, chest x-ray and echocardiogram.
Cardiac tamponade may be a true emergency that is treated by pericardiocentesis, a procedure where a long needle is inserted through the chest wall into the pericardial sac and fluid is removed. This relieves the pressure within the sac and temporarily resolves the acute emergency. A plastic tube or catheter may be left in the chest until the underlying illness that cause the tamponade is addressed and further accumulation of fluid in the pericardium is prevented. Admission to the hospital is usually required.
Constrictive pericarditis
If the heart or the pericardial sac is damaged because of trauma, or disease invades the space, then there can be scarring of the space. This scarring can prevent the heart from expanding to collect blood from the body. This limits the ability of the heart to function because it cannot collect blood and pump it to the lungs and then back to the body. The heart is constricted and cannot dilate normally. There may or may not be fluid detectable around the heart.
Bleeding into the pericardium from trauma or from a heart operation is the most common cause of constrictive pericarditis, but tumors, or infections like
tuberculosis or fungus can also be the cause.
The constriction occurs slowly over time and will cause shortness of breath on exertion and decreased ability to exercise. Swelling in the legs and the abdomen may exist because it is difficult for blood to return to the heart and fluid leaks out into the tissues.
Diagnosis is made again by history, physical examination, EKG, echocardiography and sometimes
computerized tomography (CT) of the chest.
If there is significant scarring of the pericardial sac, pericardotomy, an operation to split open the pericardium to free up the constriction around the heart may be required to improve function.
Next: Pericarditis At A Glance »
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