Pericarditis – Diagnosis and Treatment
Diagnosis
Tests Used to Check for Pericarditis
Doctors use several methods to find out if a person has pericarditis or another problem affecting the heart. Here are some ways they check for this condition:
1. Health Review and Physical Exam
Doctors ask about symptoms such as chest pain, trouble breathing, tiredness, and fever.
They press and listen to the chest with a stethoscope, trying to hear a “pericardial friction rub,” a scratchy sound that means the heart’s outer layer is inflamed.
2. Blood Work
Blood tests show if there is infection or inflammation in the body. Common things measured are:
- C-reactive protein (CRP): Shows swelling or irritation.
- Leukocytosis: Checks if white blood cell numbers are high, which can mean infection.
- Tests for heart attack signs, since heart problems can look similar to pericarditis.
3. Heart Rhythm Exam (Electrocardiogram/ECG)
This test tracks the heart’s electrical signals. It can spot changes, like ST-segment elevation, which can suggest pericarditis instead of a heart attack.
Some cases, like Dressler’s syndrome or myopericarditis, show certain patterns.
4. Images of the Chest (Chest X-ray)
A simple X-ray lets doctors see if the heart looks too big or if there’s extra fluid around it (pericardial effusion). This test can hint at chronic constrictive pericarditis or other causes.
5. Heart Ultrasound (Echocardiogram)
Echocardiograms use sound waves to show live pictures of the heart. Doctors can see swelling or fluid pressing against the heart, which could cause tamponade.
It also checks if the heart is pumping as it should.
6. CT and MRI Scans
A cardiac CT scan uses X-rays to show the heart and chest in detail. It helps find heart thickening from constrictive pericarditis or checks for trauma.
A cardiac MRI gives very detailed views and shows inflammation or scarring of the heart’s lining. This can help find causes such as autoimmune disease, kidney problems like uremic pericarditis, or chronic cases.
Summary Table
| Test Type | What It Shows |
|---|---|
| Blood tests | Signs of swelling, infection, or heart attack |
| Electrocardiogram (ECG) | Changes in heart rhythm linked to pericarditis |
| Chest X-ray | Heart size, shape, fluid around the heart |
| Echocardiogram | Heart’s movement, pericardial effusion |
| Cardiac CT/MRI | Tissue swelling, thickening, scarring, complications |
Doctors use these tests to figure out if someone has pericarditis, what caused it, and if it is acute, recurrent, or chronic constrictive pericarditis. They also check for complications like tamponade or other heart problems.
Treatment
Medicines Used to Treat Pericarditis
Doctors often start with medicines to lower pain and swelling. Common choices include nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen. These help with mild to moderate pain and reduce inflammation.
| Medication Type | Purpose |
|---|---|
| NSAIDs | Pain & inflammation relief |
| Colchicine | Reduce inflammation, prevent relapse |
| Corticosteroids | Decrease persistent inflammation |
| Immunosuppressants | Control immune-related inflammation |
| Immunomodulators | Adjust immune system activity |
| Antibiotics | Treat bacterial causes |
Over-the-counter NSAIDs are often enough, but sometimes doctors prescribe stronger forms. Colchicine is another option. It lowers inflammation and helps people with recurrent pericarditis or if symptoms do not improve with NSAIDs.
Colchicine is not safe for everyone, especially those with kidney or liver disease. Doctors check health history before prescribing it, since it can interact with other treatments.
Corticosteroids are used if NSAIDs and colchicine do not work or if pericarditis keeps coming back. These medicines lower inflammation quickly but can have side effects if used for a long time.
In cases linked to autoimmune diseases, immunosuppressants or immunomodulators like interleukin-1 blockers may be used to slow the immune system and lower inflammation.
If a bacterial infection triggers pericarditis, doctors use antibiotics. Sometimes, extra fluid builds up around the heart and causes cardiac tamponade, which may need hospital care and procedures to drain the fluid.
Heart Procedures and Surgical Options
Sometimes, medicines do not control symptoms or fluid builds up around the heart, causing more serious problems such as cardiac tamponade. In these cases, doctors use procedures.
Pericardiocentesis is a common method. Doctors insert a thin needle or tube to drain fluid from the sac around the heart, which helps the heart pump normally again. This is often done in emergencies.
For people with frequent or severe cases that do not improve, doctors may recommend surgery. Pericardiectomy removes part or all of the pericardium, the sac around the heart.
Doctors usually reserve this for patients with constrictive pericarditis or those who have not improved with other treatments.
Doctors may use hemodialysis if a person has kidney failure leading to pericarditis. Heart surgery or radiation therapy are only used in specific cases, depending on the cause of symptoms.
Care is adjusted based on the person’s overall health and the main reason for their pericarditis.
Habits and Care at Home
Rest is important for people with mild pericarditis. Common steps include resting and using over-the-counter pain medicines as directed by a healthcare provider.
Helpful tips:
- Pause intense exercise or sports.
- Follow your doctor’s advice on medications.
- Ask about the right time to return to activities.
Rest allows the body to heal and helps reduce symptoms.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Preparation can help make a medical appointment more useful and less stressful. Patients should check with the clinic to see if any fasting or special steps are needed before arrival.
It helps to bring a written list of current symptoms, noting how long each one has lasted. Write down if similar symptoms happened before and when. Include any other ongoing or recent health problems.
Keep a written record of all current medications. List the names, doses, and how often each is taken. This includes prescriptions, over-the-counter items, vitamins, and supplements.
Bringing a support person is often helpful. A trusted friend or family member can help remember the details discussed during the appointment.
Prepare a list of questions you want to ask. These may include:
- What could be causing my symptoms?
- What tests are needed, and will I need to stay in the hospital?
- What are the suggested treatments?
- How soon should the symptoms improve after starting treatment?
- What side effects could the treatments have?
- Is there a risk of complications over time?
- How often should there be follow-up visits?
- Are there activity or diet rules to follow?
- How should this condition be managed with other health issues?
Write down any other concerns or questions and bring them to the visit.
Simple Checklist Before Your Appointment
| Task | Done (✔/✖) |
|---|---|
| Called clinic to check for special instructions | |
| Wrote down symptoms and how long they last | |
| Listed other health problems | |
| Made a complete medicine list | |
| Brought a friend or family member | |
| Prepared a list of questions |
What Your Healthcare Team May Ask You
Healthcare professionals will ask about your symptoms and medical history. When you prepare to answer their questions, you can use your appointment time more effectively.
You should expect questions like:
- What symptoms do you have, and where do you feel pain?
- When did your symptoms start?
- Did your symptoms come on quickly or gradually?
- Has this happened to you before?
- Are you having any trouble breathing?
- Does your body position affect the pain?
- Have you had any recent illness, such as a cold or fever?
- Have you lost weight recently without explanation?
- Does anyone in your family have heart conditions?
- Do you smoke now or have you smoked in the past? If so, how much?
When you answer these questions honestly and clearly, your provider can give you better advice and care during your visit.
