The pericardium is a connective tissue layer, like a sac, that surrounds the heart. It contains a fluid that lubricates the outside of the heart. The pericardium is opened during cardiac bypass surgery in order to access the heart for the operation. The pericardium generally heals without a problem, but certain complications involving the pericardium can arise after heart surgery.
Acute Pericarditis
Trauma such as the incision of the pericardial wall to access the heart can cause immediate inflammation in the pericardium. Symptoms include chest pain that is likely sudden in onset, feels sharp and is worsened with inspiration. It may feel worse when lying down and better sitting up. There may also be a fever. Acute pericarditis can also be caused by infection of the pericardial sac after surgery.
Dressler's Syndrome
Dressler's syndrome also causes pericarditis, with symptoms of chest pain and fever. However, Dressler's syndrome is different in two ways: First, there tends to be a longer delay between the insult, such as surgery, and the development of pericarditis. Second, it is caused by the immune system reacting against proteins in the pericardium.
Pericardial Effusion
A pericardial effusion occurs when the space between the heart and the pericardial sac fills with excess fluid. Since there is limited space, the excess fluid can exert pressure on the heart. A small pericardial effusion usually does not cause any symptoms. A large pericardial effusion can cause heart problems.
Cardiac Tamponade
Cardiac tamponade occurs when the fluid buildup around the heart during a pericardial effusion exerts a dangerous amount of pressure on the heart. The pressure from the surrounding fluid prevents the heart from filling with blood and therefore prevents the heart from pumping blood to the rest of the body, as well as to itself. If the heart is deprived of blood, it will quickly develop an abnormal rhythm and stop beating, according to "Harrison's Principles of Internal Medicine," by Dr. Anthony S. Fauci et al.
References
- "Robbins & Cotran Pathologic Basis of Disease"; Vinay Kumar et al.; 2009
- "Harrison's Principles of Internal Medicine"; Anthony Fauci et al.; 2008
