Pericarditis

What is pericarditis?

Pericarditis is an inflammation of the pericardium, the sac-like tissue layer that surrounds the heart. It can cause chest pain that is often sudden and short-lived.

When the pericardium is inflamed, it produces fluid. A large amount of fluid can compress the heart, limiting its ability to fill normally with blood. This can cause tachycardia (rapid pulse rate) and hypotension (reduced blood pressure) and chest pain.

What are the symptoms of pericarditis?

Typical symptoms of pericarditis include fever and chest pain. The chest pain is often more severe when lying down and is less severe when sitting up and leaning forward.

What causes pericarditis?

There are multiple causes for pericarditis including:

  • infections: including viral, bacterial (such as tuberculosis), fungal, and protozoal
  • postpericardiotomy syndrome (Dressler’s syndrome), which occurs in a small number of patients after heart surgery
  • rheumatologic diseases, including systemic lupus erythematosus, rheumatoid arthritis, and rheumatic fever
  • Kawasaki disease
  • medications that can cause inflammation, such as hydralzaine and procainamide
  • kidney failure
  • high-dose radiation associated with treatment of certain cancers, such as Hodgkin lymphoma

How is pericarditis diagnosed?

Pericarditis might be suspected if your child has chest pain or if the physician hears an abnormal heart sound called a “rub,” which occurs when the pericardium is irritated.

In addition to a complete medical history and physical examination, tests to diagnose pericarditis may include:

  • blood tests to evaluate the degree of inflammation
  • chest x-ray
  • echocardiogram (cardiac ultrasound)

What are the treatments for pericarditis?

Treatment depends on the cause of the inflammation and the amount of extra fluid in the chest. Many cases are mild and may improve with rest. Your child’s doctor may recommend over-the-counter medications to help with pain.

More severe cases may result in pericardial tamponade, a buildup of fluids that increases pressure on the heart. This may require emergency drainage of excess fluids. In rare cases, some children may need surgery.

If the pericarditis is caused by an infection, the doctor may prescribe antibiotics or other medications to treat the infection.

How we care for pericarditis

At Boston Children’s Hospital, our clinicians in the Heart Center are experienced in diagnosing and treating all types of heart problems, including pericarditis.