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Typical symptoms associated with pericarditis include fever and chest pain. The chest pain is often more severe
when the patient lies down and is less when the patient sits up and leans forward. When the pericardium is inflamed, it produces fluid. A large amount of fluid can compress the heart, limiting the ability of the heart to fill normally with blood, and thereby producing tachycardia (rapid pulse rate) and hypotension (reduced blood pressure). A large amount of fluid will produce muffling of the heart sounds. When the fluid collection is large, a chest radiograph will demonstrate an enlarged heart shadow. Echocardiography can clearly delineate the amount of fluid and possible hemodynamic compromise. An electrocardiogram may show changes in the ST-T waves, with either elevation of the ST segment or inversion of the T waves, depending on the stage of the illness.
Treatment depends on the etiology of the inflammation and size of the pericardial fluid collection. Large fluid collections usually require drainage which can be accomplished non-surgically by placement of a draining catheter. Access is usually attained from a subxiphoid approach (under the rib cage in the middle of the chest). Anti-inflammatory medication is helpful for many etiologies of pericarditis, and may include non-steroidal agents (ibuprofen, indomethacin, colchicine) or steroids (prednisone). Bacterial, fungal, or protozoal infections require drainage for diagnosis and subsequent use of antibiotics.
For in-depth visual and audio information on this condition, visit the Children's Hospital Boston Multimedia Library.
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