Pericardial Disease


What is the Pericardium?

The pericardium is a thin walled sac that surrounds the heart. It contains a very small amount of fluid to provide lubrication for the heart and also provides the heart with protection.


What types of diseases affect the pericardium?

Two main diseases affect the pericardium and may be related to each other. Pericarditis is inflammation of the pericardium. A pericardial effusion is the accumulation of fluid around the heart. Causes may include:

  • Viral, bacterial, fungal or parasitic infection
  • inflammation following heart surgery or heart attack
  • autoimmune disorders such as rheumatoid arthritis or lupus
  • waste products in the blood due to kidney failure
  • under-active thyroid
  • HIV/AIDS
  • metastasis of cancer
  • radiation therapy for cancer if the heart was within the field of radiation

Sometimes the cause of pericardial effusion cannot be determined, in which case it is termed "idiopathic". This may be due to a limited viral infection or inflammatory condition that cannot be detected by typical lab tests.


What are common symptoms of pericardial disease?

Symptoms of pericardial disease such as pericarditis or pericardial effusion may consist of chest pain, shortness of breath, palpitations, fever, rapid heart rate, dizziness, or passing out. Chest pain may be related to taking a deep breath, or certain body positions (leaning back or forwards).

If too much fluid accumulates around the heart, it may cause a life-threatening condition called cardiac tamponade. This problem is serious because the fluid outside the heart prevents the heart from expanding enough to fill with blood. As a result, there is not enough blood in the heart to supply the needs for the rest of the body. If this occurs, the fluid must be removed immediately.


How is pericardial disease diagnosed?

There are several common methods to evaluate for pericardial disease. An electrocardiogram (EKG) measures electrical signals from the heart. An echocardiogram (ultrasound test of the heart) can show pericardial fluid and assess the heart’s function. Other tests may include bloodwork, chest X-ray, or CT scan. In rare cases, a sample of the fluid may be taken with a needle (pericardiocentesis; see below).


Treatment for pericardial disease

Treatment consists of treating the underlying cause if it can be identified. For pericarditis, medications for pain and inflammation such as ibuprofen, aspirin, indomethacin, or in some cases steroid medications such as prednisone may be prescribed. Colchicine is often used to prevent recurrence of pericarditis. Pericarditis due to viral infection typically resolves on its own.

For a pericardial effusion that is large or affecting the heart’s function, drainage may be required. This can be done with a needle (pericardiocentesis). Alternatively, some pericardial effusions require a surgical procedure (pericardial window) in which a surgeon creates an opening in the pericardial sac. This allows excess fluid to safely drain into the abdominal cavity or lung cavity, where it may be absorbed by the body.


Long-Term Prognosis

Pericarditis due to a viral infection usually resolves on its own with the help of anti-inflammatory medications. The course of pericardial disease due other illnesses may vary based upon treatment on the underlying problem. In a small percentage of patients, pericarditis and/or pericardial effusion may return (recurrent pericarditis) which requires additional therapy for treatment and suppression.