The pericardium is a thin membrane that surrounds and protects your heart. This membrane helps prevent infection and also keeps your heart from expanding too much. Diseases and health problems can cause an inflammation of this membrane, or pericarditis. The causes of pericarditis include:
- fungal infections
- parasitic infections
- trauma from surgery or another injury
The symptoms of bacterial pericarditis depend on the severity of your condition and any underlying health problems. The most common symptom is sharp, stabbing chest pain, also known as pleuritis. This pain often moves or radiates to other parts of the body, including the left shoulder and neck.
Other symptoms that may occur with bacterial pericarditis include:
- pain when you breathe
- shortness of breath when lying down
- a fever
- a dry cough
- a general feeling of sickness, or malaise
- splinting of the ribs, causing you to bend over and hold your chest while breathing
- edema, or swelling in your abdomen or legs
This condition occurs when certain bacteria enter the pericardium and cause infection. The most common bacteria to cause pericarditis are Staphylococcus, Streptococcus, and Pneumococcus.
Bacteria can enter the pericardium:
- through your bloodstream from another infection in the body, such as pneumonia
- from an infection in another part of the heart
- through surgery
- when a catheter is inserted to drain fluid from the pericardium
- as a result of trauma
People with a weak immune system are at an increased risk of developing bacterial pericarditis because their bodies are less able to fight infection. Health problems that may increase your risk of developing this disorder include:
- immune deficiency conditions such as HIV or AIDS
- chronic diseases, such as diabetes
- alcohol abuse
- vascular heart disease
- uremia, or excess uric acid in your blood
According to the Cleveland Clinic, men between 20 and 50 are more likely to develop this condition. Bacterial pericarditis often develops following a lung infection.
Your doctor will perform a physical exam to see if you have the symptoms of bacterial pericarditis. They’ll use a stethoscope to listen for sounds in your chest. If you have bacterial pericarditis, they’ll be able to detect pericardial rub, which is a sound that occurs when the layers of the infected pericardium rub together.
Your doctor may also check to see if you have:
- sepsis, which is a severe and potentially life-threatening infection that can spread throughout your body
- pericardial effusion, or fluid buildup in your pericardium
- pleural effusion, or fluid buildup in the area around your lungs
If you have any of these conditions, your doctor will order additional tests to confirm a diagnosis. These tests may include:
- a CT scan of your chest
- an MRI of your chest
- an X-ray of your chest, specifically of the lungs, heart, large arteries, ribs, and diaphragm
- an echocardiogram, which is a test that uses sound waves to create a moving image of your heart
- an electrocardiogram to measure the electrical impulses your heart gives off
If you have pericarditis, your doctor will need to determine if bacteria have caused it. Your doctor may need to order tests to detect the presence of harmful bacteria. These tests include:
- blood cultures
- a complete blood count
- a culture of the pericardial fluid
- a gram stain of the pericardial fluid
The goal of treatment is to cure the infection. Bed rest is important, and you’ll also need to elevate your head while lying down to reduce the 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 of the pericardium
- diuretics to reduce fluid volume in your body
If your condition is severe, you may need surgery, including:
- a subxiphoid pericardiotomy, which involves making a hole in your pericardium to allow fluid to drain out
- a pericardiocentesis, which involves inserting a catheter to drain fluid from your pericardium
- a surgical pericardiectomy, which involves removing part of your pericardial sac
Some people develop a condition known as chronic pericarditis, in which infection lasts for six months or more, or frequently recurs. Doctors only remove the pericardium if other treatments can’t stop the infection from occurring again.
Complications from this condition can include:
- cardiac tamponade, which is compression of the heart caused by the buildup of fluid in the space around your heart muscle
- constrictive heart failure, which occurs when your heart can’t pump enough blood to the rest of your body
- pulmonary edema, which is an abnormal fluid buildup in the sacs of your lungs
If you develop any of these complications, it may be more difficult to treat your pericarditis and it may lead to chronic pericarditis.
Your outlook depends on whether you develop any other health complications. Other complications will need treatment. This prolongs the period of illness and increases the risk of permanent damage and recurrence of infection.
Early detection and diagnosis are important to stop and treat bacterial pericarditis before it spreads and creates other complications. If you get the proper treatment, it can last up to three months, and you can recover completely and return to normal activities once the infection goes away. If you don’t get treatment, it can lead to other health issues and it can be fatal.