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Pericarditis

Inflammation of the pericardium (the double-layered membrane surrounding the heart). This disorder usually leads to fever and chest pain.  There can also be an increased amount of fluid in the pericardial space, which separates the two smooth layers of the pericardium.  The excess fluid can restrict and compression the action of the heart.

Long term inflammation of the pericardium can cause a condition called constrictive pericarditis, in which the pericardium becomes scarred, contracts and thickens, and as a result impedes the heart’s action.

Causes

Causes of pericarditis include infection; myocardial infarction (heart attack); injury to the pericardium; and cancer spreading from another site.  The disorder can accompany the autoimmune conditions systemic lupus erythematosus and rheumatoid arthiritis, or kidney failure.

Symptoms

The main symptom is a sharp pain behind the sternum (breast bone) and sometimes in the neck and shoulders, which can be more extreme if the person takes a deep breath, swallows or changes position.  The pain can be relieved by sitting up and leaning forward, there can also be a fever, constrictive pericarditis causes oedema (swelling due to accumulation of fluid) of the abdomen and legs. 

Diagnosis and treatment

Diagnosis is sought from a physical examination, from an ECG (which records the electrical activity in the heart) and chest X-rays or echocardiography, which will show any excess fluid surrounding the heart.

If possible, treatment is aimed at the cause.  Anti-inflamatory or analgesic drugs can be administered.  If there is an effusion, the excess fluid can be drawn off through a needle.  In extreme constrictive pericarditis, the thickened part of the pericardium can be surgically removed so that the heart can pump freely.


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