Pericardial Disease
Conditions affecting the sac that surrounds the heart
Quick Facts
- Type: Heart (cardiovascular) condition
- Affected structure: The pericardium around the heart
- Main forms: Inflammation, fluid buildup, stiffening
- Seek urgent care: Severe chest pain, breathlessness, fainting
Overview
The pericardium is a thin, two-layered sac that surrounds the heart, holding it in place and protecting it. Pericardial disease is a general term for conditions that affect this sac. The most common forms include inflammation of the pericardium (pericarditis), a buildup of fluid between its layers (pericardial effusion), and stiffening or scarring that restricts the heart (constrictive pericarditis).
These conditions can range from mild and self-limiting to serious and life-threatening, depending on how much they interfere with the heart's ability to fill and pump blood. Many cases improve with treatment, but some, such as a rapid large fluid buildup that compresses the heart, are medical emergencies. Knowing the warning signs helps people seek timely care.
A small amount of fluid normally sits between the two layers of the pericardium to let the heart move smoothly. When the pericardium becomes inflamed, fills with excess fluid, or stiffens, this smooth function is disrupted. A particularly dangerous situation, called cardiac tamponade, occurs when fluid builds up quickly and presses on the heart so that it cannot fill properly, which requires emergency treatment.
Symptoms
Symptoms depend on the type and severity of the pericardial problem.
- Chest pain, often sharp, that may worsen with breathing in or lying down and ease when sitting forward (typical of pericarditis)
- Shortness of breath, especially when lying flat
- Fatigue, weakness, or lightheadedness
- Heart palpitations
- Swelling of the legs or abdomen with chronic forms
- Fever, in cases linked to infection or inflammation
Warning signs of a serious problem include severe or worsening chest pain, marked breathlessness, fainting, or a feeling of pressure with a rapid heartbeat, which can signal that fluid is compressing the heart.
Causes
Pericardial disease has many possible causes, though sometimes no cause is found.
- Infections: Often viral, and less commonly bacterial or other infections.
- Inflammatory and autoimmune conditions: Such as lupus and rheumatoid arthritis.
- Heart-related causes: After a heart attack or heart surgery.
- Other causes: Kidney failure, cancer, radiation therapy, certain medications, and injury.
When no specific cause is identified, the condition is described as idiopathic, which is common with pericarditis.
Risk Factors
- A recent viral infection
- Autoimmune or inflammatory diseases
- A recent heart attack or heart surgery
- Kidney failure or certain cancers
- Previous radiation therapy to the chest
Diagnosis
Doctors diagnose pericardial disease using a combination of examination and tests.
- Physical exam: Listening for a characteristic rubbing sound and checking for signs of fluid or strain on the heart.
- Electrocardiogram (ECG): Can show changes typical of pericarditis.
- Echocardiogram: An ultrasound of the heart that detects fluid around it and how well it fills and pumps.
- Imaging: Chest X-ray, CT, or MRI for more detail.
- Blood tests: To look for inflammation, infection, or underlying conditions.
Treatment
Treatment depends on the type, cause, and severity.
- Anti-inflammatory medication: For pericarditis, including certain anti-inflammatory drugs and other medicines that reduce inflammation and recurrence.
- Treating the cause: Such as antibiotics for bacterial infection or managing an autoimmune disease.
- Draining fluid: A procedure to remove fluid (pericardiocentesis) when an effusion is large or compressing the heart.
- Surgery: For constrictive pericarditis or recurrent effusions, removing or opening part of the pericardium.
Many cases of viral or idiopathic pericarditis improve with rest and medication, while more serious forms need urgent or specialist treatment.
Prevention
- Treat infections and manage underlying conditions such as autoimmune disease and kidney problems
- Follow up after a heart attack or heart surgery as advised
- Take prescribed medications fully to reduce the risk of recurrent pericarditis
- Seek prompt care for chest pain so problems are caught early
When to See a Doctor
Chest pain should always be taken seriously. Call emergency services if you have severe, sudden, or crushing chest pain, pain spreading to the arm, jaw, or back, severe shortness of breath, or fainting, as these can signal a heart attack or a heart being compressed by fluid. Also see a doctor promptly for:
- Persistent or recurring chest pain, especially when breathing or lying down
- Worsening breathlessness or swelling
- Fever with chest discomfort
- Palpitations with lightheadedness
Frequently Asked Questions
What is the pericardium?
The pericardium is a thin, two-layered sac that surrounds the heart. It holds the heart in position and protects it, with a small amount of fluid between the layers to reduce friction. Pericardial disease refers to conditions that inflame, fill with fluid, or stiffen this sac.
Is pericardial disease dangerous?
It ranges from mild to life-threatening. Many cases of viral or idiopathic pericarditis improve with treatment. However, a rapid buildup of fluid that compresses the heart, or severe stiffening that restricts it, can be dangerous and needs urgent care. Severe chest pain, breathlessness, or fainting are emergencies.
How is pericarditis treated?
Pericarditis is often treated with anti-inflammatory medication and rest, and additional medicines may be used to reduce the chance of it recurring. If an underlying cause such as infection or autoimmune disease is present, that is treated as well. Large fluid collections may need to be drained.
When is chest pain from the heart an emergency?
Call emergency services for severe, sudden, or crushing chest pain, pain spreading to the arm, jaw, or back, severe shortness of breath, fainting, or a racing heart with lightheadedness. These can signal a heart attack or fluid compressing the heart and need immediate care.
References
- Mayo Clinic. Pericarditis — Symptoms and causes.
- American Heart Association. Pericarditis and pericardial disease.
- MedlinePlus, U.S. National Library of Medicine. Pericardial disorders.
- National Heart, Lung, and Blood Institute (NHLBI). Pericarditis.