Chronic Pericarditis

The heart is enclosed in the pericardium, a flexible, two-layered sac. The pericardium keeps the heart in place, prevents it from filling with too much blood and protects the heart against chest infections.

When the pericardium becomes inflamed (red and tender) and fluid and blood cells fill the space between its two layers, the condition is called pericarditis. Unlike acute pericarditis, which begins suddenly, chronic pericarditis builds up gradually, does not go away quickly and causes fluid to collect between the layers of the pericardium or causes the pericardium itself to thicken.

There are two general types of chronic pericarditis:

  • Chronic effusive pericarditis, in which fluid slowly builds up in the space between the two layers of the pericardium, and
  • Chronic constrictive pericarditis, a rare disease that develops scar-like, fibrous tissue forms throughout the pericardium. The tissue shrinks over time and puts pressure on the heart. When this happens the heart cannot enlarge as it should and more pressure is need to fill the heart. This in turn causes fluid to collect in the veins, then leak out and cause swelling (edema) in other parts of the body.
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Symptoms

Symptoms of pericarditis include:

  • Coughing, which develops because the high pressure in the veings of the lungs causes fluid to be forced into the air sacs of the lungs.
  • Fatigue, which is caused by interference with the heart's pumping action that prevents enough blood circulating to meet the body's needs
  • Fluid pooling between the two layers of the membrane that covers the lungs (the pleura)
  • Shortness of breath
  • Swelling as fluid accumulates in the abdomen (ascites) or the legs (edema)

Chronic pericarditis does not cause pain.

In cases of chronic effusive pericarditis, there may be few or no symptoms, if the fluid collects slowly. This is because the pericardium can stretch gradually. However, if fluid collects quickly, the heart can become compressed and cardiac tamponande may occur.

Causes and Risk Factors

Usually, it is not possible to identify what causes chronic pericarditis.

Chronic effusive pericarditis may be caused by cancer, tuberculosis or an underactive thyroid gland (hypothyroidism).

Chronic constrictive pericarditis may be caused by infections, radiation therapy for breast cancer or lymphoma or any condition that causes acute pericarditis, including rheumatoid arthritis, lupus, injury or heart surgery.

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Diagnosis

Your doctor will take your medical history, note your symptoms and do a physical examination. If your symptoms are occurring without any other reason such as high blood pressure, coronary artery disease or a heart valve disorder to cause your symptoms, chronic pericarditis will be suspected.

Your doctor may order the following tests:

  • A biopsy, in which a sample of the pericardium is removed during exploratory surgery and looked at under a microscope. This may help determine the cause of the condition
  • Cardiac catheterization to measure the blood pressure in the chambers of the heart and major blood vessels. This can help your doctor distinguish whether your symptoms are due to pericarditis or some other condition
  • Chest X-rays to identify if there are calcium deposits in the pericardium. These developing about half the people who have chronic constrictive pericarditis
  • Computed tomography (CT), which can also measure the thickenss of the pericardium