Pericarditis is an inflammation of the pericardium, the sac that surrounds the heart. Chest pain is a common symptom with pericarditis that can mimic the pain seen with heart attacks. Distinguishing pericarditis from a heart attack requires obtaining a thorough history of the pain and appropriate diagnostic tests. Treatment for pericarditis is very different than that for heart attacks.
History
There are many potential causes of pericarditis. Most causes are associated with a virus, but trauma, bacterial infections, malignancies and myocardial infarction are also known causes. Both adults and children can develop pericarditis. With pericarditis, the pericardium becomes inflamed, squeezing the heart and restricting its action, causing chest pain.
Symptoms
The "Journal of Cardiovascular Nursing" notes that in pericarditis, chest pain and fever are the most common symptoms. Other symptoms include difficulty breathing, shortness of breath, weakness, cough and chills. Pain associated with pericarditis is typically a persistent sharp, stabbing pain aggravated by breathing in and coughing. If you have pericarditis, the symptoms are often relieved by sitting upright and leaning forward. A classic sign associated with pericarditis is called a pericardial rub. If you were to listen to your heart with a stethoscope, the pericardial rub creates a grating or creaking sound. Although this is a classic sign, by itself, it does not rule pericarditis vs. a heart attack.
Laboratory Tests
Laboratory tests are used to help confirm the cause of pericarditis or exclude other possible causes. No single test is diagnostic of pericarditis. A complete blood count may be done to help identify pericarditis. Within the complete blood count, the white blood cell count may be elevated, which could help determine if a bacterial infection is the underlying cause. Cardiac laboratory studies are done to help rule out a heart attack. Cardiac studies include cardiac enzymes and troponin. Cardiac enzymes are also known as CPK, LDH and SGOT. These enzymes are normally found in the bloodstream in low levels, but if there is injury to the heart muscle, these enzymes will have abnormal elevation. Troponin is another cardiac study that is a sensitive indicator specific to heart muscle.
Electrocardiogram
The electrocardiogram is indicated for patients with chest pain and can aid in the diagnosis and treatment decision. Pericarditis findings on an electrocardiogram are distinctly different than those seen with a heart attack.
Treatment
Once the diagnosis of pericarditis has been made and other causes of chest pain have been ruled out, you can usually be managed as an outpatient and not require hospitalization. Treatment will focus on pain control and reducing inflammation. The use of nonsteroidal anti-inflammatory agents is the primary medication used for pain and reducing inflammation. Education of the diagnosis and complications are important for you to know and understand. Any worsening or relapse of pain should be evaluated by your physician.
References
- "Journal of Cardiovascular Nursing"; Pericarditis Inflammation or Infarction; T. Carter, C. Brooks; July/August 2005
- "Patient Care"; Update on Managing Acute Pericarditis; Mark Marinella, Ralph Shabetai, David Spodick; March 2006
