The pericardium is a thin membrane that surrounds and protects your heart. This membrane helps prevent infection. It also keeps the heart from over-expanding. Certain diseases and health problems can cause an inflammation of this membrane. This is known as pericarditis.
Pericarditis can be caused by
- fungal infections
- parasitic infections
- trauma from surgery or other injury
When the inflammation is caused by bacteria, it is called bacterial pericarditis.
This condition occurs when certain bacteria enter the pericardium and cause infection. The most common bacteria that cause bacterial pericarditis are Staphylococci and Streptococci. Other bacteria can also cause this condition, including Pneumococci.
Bacteria can enter the pericardium in a number of ways:
- it can spread through the blood from another infection in the body, such as pneumonia
- it can spread from an infection in another part of the heart
- it can be introduced during surgery
- it can be introduced when a catheter is inserted to drain fluid from the pericardium
- it can be introduced as a result of trauma
Patients with other health problems are at a greater risk for developing bacterial pericarditis because their bodies are less able to fight the infection. Health problems that may increase your risk for developing this disorder include:
- a weakened immune system due to conditions such as HIV/AIDS
- chronic diseases, such as diabetes
- alcohol abuse
- vascular (heart) disease
- uremia (excess uric acid in the blood)
Men aged between 20 and 50 are also more likely to develop this condition. In this group, bacterial pericarditis often develops following a lung infection.
The symptoms of bacterial pericarditis will depend on the severity of your condition. They will also depend on the presence of any underlying health problems.
Other symptoms that may occur with bacterial pericarditis include:
- pain when you breathe
- shortness of breath when lying down
- dry cough
- general feeling of sickness (malaise)
- needing to bend over and hold your chest while breathing (splinting of the ribs)
- swelling (edema) in the abdomen or leg
Bacterial pericarditis can be diagnosed by your doctor. He or she will perform a physical exam to see if you have the above symptoms. In particular, your doctor will use a stethoscope to listen to the sounds in your chest. If you have bacterial pericarditis, your doctor will be able to detect what is known as a pericardial rub. This sound occurs when the layers of the infected pericardium rub together.
Your doctor may also check to see if you have
- sepsis (a severe infection that has spread through the body)
- pericardial effusion (fluid that has built up in the pericardium)
- pleural effusion (fluid that has built up in the area around the lungs)
If you have any of these conditions, your doctor will order additional tests to confirm your diagnosis. These include
- CT scan (cross-sectional X-rays)of the chest
- MRI of the chest (a scan that uses magnets and radio waves to create cross-sectional pictures of the chest area)
- X-ray of the chest (X-ray of the lungs, heart, large arteries, ribs, and diaphragm)
- Echocardiogram (a test that uses sound waves to create a moving picture of the heart)
- electrocardiogram (to measure the electrical impulses given off by your heart)
If you have pericarditis, your doctor will need to determine if it is caused by bacteria. To do this, your doctor may order tests to detect the presence of harmful bacteria, including:
- blood cultures
- a complete blood count (CBC)
- culture of the pericardial fluid
- gram stain of the pericardial fluid
Treatment is aimed at curing the infection. Your doctor may recommend bed rest. You will need to elevate your head while lying down. This will reduce strain on your heart.
Your doctor may also prescribe medications, including
- antibiotics to treat the infection
- over-the-counter or narcotic pain relievers
- corticosteroids to reduce inflammation in the pericardium
- diuretics to reduce fluid volume in the body
In most cases, you will need only medication to treat bacterial pericarditis. If your condition is severe, your doctor may need to use surgical treatments. These can include:
- subxiphoid pericardiotomy (cutting a hole in the pericardium to allow the fluid to drain out)
- pericardiocentesis (inserting a catheter to drain fluid from the pericardium)
- surgical pericardiectomy (removing a part of the pericardial sac)
Removal of the pericardium is only done if other treatment does not stop the infection from occurring again. Some people develop a condition known as chronic pericarditis. This means that your infection returns even with treatment or lasts for six months or more.
If left untreated, bacterial pericarditis can be fatal. With proper treatment, you can recover completely. Your outlook will depend on whether you develop any health complications because of this condition.
Complications from this condition can include:
- cardiac tamponade (compression of the heart caused by buildup of fluid in the space around the heart muscle)
- constrictive heart failure (the heart is not able to pump enough blood to the rest of the body)
- pulmonary edema (abnormal buildup of fluids in the sacs of the lungs)
If you develop any of these complications, your outlook may not be as positive. You may also develop chronic pericarditis. If this condition develops, talk to your doctor about your treatment options and what you can expect.