Pericarditis - bacterial

Definition

Bacterial pericarditis is irritation and swelling of the sac that surrounds the heart (pericardium), due to infection by bacteria.

See also: Pericarditis

Alternative Names

Purulent pericarditis

Causes, incidence, and risk factors

Bacterial infections are one cause of pericarditis. Since the introduction of antibiotics, bacterial pericarditis has become rare.

It most often occurs in men between the ages of 20 and 50, usually after some type of respiratory infection. It can also occur after skin or mouth infections that produce bacterial infection of the blood (bacteremia) and after heart surgery.

The bacterial infection causes the pericardium to become swollen and inflamed. Pain occurs as a result of the inflamed pericardium rubbing against the heart. Fluid may build up in the pericardial sac.

The most common bacteria that cause this condition are:

• Haemophilus influenza (also called H. flu)
• Meningococci
• Pneumococci
• Staphylococci
• Streptococci

Symptoms

• Anxiety
• Chest pain
  • May move (radiate) to the neck, shoulder, back, or abdomen
  • Pain increases with breathing
  • Sharp, stabbing
  • Sitting up or standing relieves pain
• Chills
• Difficulty breathing
• Dry cough
• Fatigue
• Fever
• Splinting of ribs with deep breathing (bend over and hold chest when breathing)
• Sweating

Signs and tests

Signs include:

• Faint or far away sounding heart sounds
• Rubbing sound heard when listening to the heart through a stethoscope
• Septic shock
• Signs of fluid in the pericardium (pericardial effusion)
• Signs of fluid in the space around the lungs (pleural effusion), such as decreased breath sounds
• Signs of pneumonia

Doctors may suspect pericarditis when one of the following tests shows an abnormal amount of fluid in the pericardial sac:

• Chest CT scan
• Chest MRI scan
• Chest x-ray
• Echocardiogram

This condition is diagnosed when the fluid around the pericardial sac is shown to be infected with bacteria. The following tests help doctors make this diagnosis:

• Blood cultures
• CBC showing increased WBC count
• Pericardial fluid culture
• Pericardial fluid gram stain

Treatment

The goal of treatment is to cure the infection.

Medications include:

• Antibiotics to treat bacterial infections
• Analgesics to relieve pain
• Aspirin, ibuprofen, or other nonsteroidal anti-inflammatory medications (NSAIDS) to relieve inflammation of the pericardium
• Diuretics to remove excess fluid

Bedrest with the head of the bed raised may reduce the workload on the heart.

Other treatments include:

• Cutting a small hole (window) in the pericardium (subxiphoid pericardiotomy) to allow infected fluid to drain
• Draining fluid from the pericardial sac (pericardiocentesis) to prevent or treat cardiac tamponade
• Pericardial stripping or removing part of the pericardium (surgical pericardiectomy) if bacterial pericarditis is chronic or comes back

Expectations (prognosis)

The disorder may be life-threatening if untreated. The outcome is good if bacterial pericarditis is treated promptly. Most people recover completely with treatment.

Complications

• Cardiac tamponade
• Constrictive heart failure
• Pulmonary edema

References

LeWinter MM. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 70.