Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
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:
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.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include light-headedness, dizziness, or even fainting if not enough blood is getting to the brain. Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
An upper respiratory infection is a contagious infection of the structures of the upper respiratory tract, which includes the sinuses, nasal passages, pharynx, and larynx. Common causes of an upper respiratory infection include bacteria and viruses such as rhinoviruses, group A streptococci, influenza, respiratory syncytial, whooping cough, diphtheria, and Epstein-Barre. Examples of symptoms of upper respiratory infection include sneezing, sore throat, cough, fever, and nasal congestion. Treatment of upper respiratory infection are generally with OTC medication and home remedies.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Coxsackie viruses may be divided into two groups. Type A causes hand, foot, and mouth disease and conjunctivitis, while type B causes pleurodynia. Both types sometimes cause meningitis, myocarditis, and pericarditis. There is no specific treatment for this disease.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Kawasaki disease is a rare children's disease characterized by a fever that lasts more than five days and at least four of the following five symptoms are present: rash, swollen neck lymph gland, red tongue, swelling or redness of the hands or feet, and conjunctivitis. High doses of aspirin are used to treat Kawasaki disease. Cortisone and antiinflammatory drugs may also be used during treatment.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
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