Pericardial Disease | William G. & Mary A. Ryan Center for Heart & Vascular Medicine | Loyola Medicine

Pericardial Disease

Overview and Facts about Pericardial Disease

Pericardial disease refers to the heart conditions that affect the pericardium — the double-layered membrane that surrounds the heart. The role of the pericardium is to provide structural support for the heart and help it work properly. Between the two layers is a small amount of fluid that keeps the layers separate, in order to prevent friction between them.

Signs and Symptoms of Pericardial Disease

Symptoms depend on the type of pericardial disease. Common types and symptoms include:

  • Acute pericarditis: Inflammation of the pericardium that begins suddenly.
    • Sudden sharp, stabbing chest pain
    • Pain in one or both shoulders
    • Fever
    • Weakness
    • Trouble breathing
    • Coughing
    • Heart palpitations
  • Chronic pericarditis develops over time and may take longer to treat.
    • Tiredness
    • Coughing
    • Shortness of breath
    • Severe cases can lead to swelling in the stomach and legs, as well as low blood pressure
  • Chronic constrictive pericarditis: long-term inflammation of the pericardium leading to thickening and a scar-like tissue forming throughout the pericardium, which prevents the heart from functioning properly.
    • Difficulty breathing
    • Fatigue
    • Swollen abdomen
    • Chronic, severe swelling in the legs and ankles
    • Weakness
    • Low-grade fever
    • Chest pain
  • Pericardial effusion: excess fluid that accumulates between the two layers of the pericardium.
    • Shortness of breath
    • Trouble breathing when lying down
    • Chest pain (usually behind the breastbone)
    • Chest fullness
  • Cardiac tamponade: a life-threatening complication of pericardial effusion that can make it difficult for the heart to expand normally. The extra fluid puts pressure on the heart, preventing it from properly filling with blood. As a result, less blood leaves the heart, which causes a sharp drop in blood pressure. If left untreated, cardiac tamponade can be fatal.
    • Chest pain
    • Shortness of breath
    • Pounding or racing heartbeat
    • Bulging veins in the neck, head, or temples
    • Weakness, lightheadedness, or fainting
    • Cool, sweaty, and bluish skin

Causes and Risk Factors of Pericardial Disease

Causes of acute or chronic pericarditis:

  • Viral or bacterial infections
  • Autoimmune disorders
  • Cancer that has spread to the pericardium
  • Kidney failure
  • Heart surgery

Causes of chronic constrictive pericarditis:

Causes of pericardial effusion:

  • Inflammation of the pericardium following heart surgery or a heart attack
  • Autoimmune disorders
  • Viral or bacterial infection
  • Cancer of the pericardium or heart
  • Radiation therapy
  • Chemotherapy drugs
  • Certain prescription drugs

Causes of cardiac tamponade:

Tests and Diagnosis of Pericardial Disease

Tests to diagnose pericardial disease may include one or more of the following:

Treatment and Care for Pericardial Disease

Treatment of these heart conditions depends on the type, the cause, and the severity. Mild cases of pericarditis, for example, may get better without treatment, or can be managed with over-the-counter, anti-inflammatory medicines to reduce pain and inflammation.

Treatment for pericardial effusion depends on the amount of fluid accumulated and the underlying cause. If the cause is an infection, antibiotics are used to treat the infection.  Severe pericardial effusion may need to be drained using a procedure called pericardiocentesis.

Early treatment for chronic constrictive pericarditis focuses on improving heart function by taking water pills to help remove excess fluids and taking pain medication or over-the-counter anti-inflammatories. In severe cases, a surgical procedure called pericardiectomy is performed to remove parts or all of the scarred pericardium.

Cardiac tamponade is a medical emergency and immediate treatment is essential, as it can rapidly become fatal. The fluid must be drained as quickly as possible. Part of the pericardium may also be removed. Doctors must also determine the underlying cause.