Pericarditis

Pericarditis is swelling and inflammation of the pericardium, a sac surrounding your heart. It can be sudden or long term. The most common form is acute (sudden) pericarditis. Mild cases may get better on their own, while more severe cases may need medication and hospitalization.

Complications can include cardiac tamponade, which happens when fluid builds up in the pericardium. This condition is more serious and may require hospitalization and possibly surgery.

Long-term pericarditis can cause constrictive pericarditis, where the sac surrounding your heart gets tight with scar tissue and keeps your heart from working properly. It also may require surgery. Pericardial effusion -- excess fluid around the heart -- and constrictive pericarditis can happen together.

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Signs and Symptoms

The signs and symptoms of pericarditis vary. But the most common symptom is sharp chest pain.

Sudden pericarditis:

• Stabbing pain on the left side of your chest
• Pain gets worse when you breathe deeply or lie down
• Low-grade fever
• Muscle pain
• Cough
• Feelings of weakness or fatigue

Pericardial effusion:

• Trouble breathing
• A bluish skin color

Constrictive pericarditis:

• Trouble breathing
• Congestion in the lungs
• Fatigue
• Abdominal swelling

What Causes It?

Many things can cause sudden pericarditis and pericardial effusion, including viruses, bacteria, fungi, cancer, trauma to the heart (such as chest injury), drug reactions, and radiation exposure. In many cases, however, the actual cause is unknown. People who have autoimmune diseases, such as lupus and rheumatoid arthritis, are more likely to develop pericarditis. Constrictive pericarditis usually happens when you have repeated (chronic) pericarditis.

What to Expect at Your Doctor's Office

Your doctor will listen to your heart and lungs looking for a distinctive sound the pericardium makes when it is inflamed and rubs against your heart. Your doctor will probably order several tests, which may include blood work, an electrocardiogram (ECG), an echocardiogram, and chest x-ray.

Treatment Options

Mild cases of pericarditis are usually treated with rest and anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen (Advil, Motrin). Your health care provider may also prescribe colchicine or corticosteroid medicines. If a bacterial infection is causing your pericarditis, you will be given antibiotics.

To treat recurring pericarditis, your doctor may use several drugs, including NSAIDs at high dosage, slow tapering of a corticosteroid, and colchicine, and watch you closely. If you develop cardiac tamponade, your doctor may recommend a procedure called pericardiocentesis, which drains fluid from your chest. Total pericardiectomy -- removal of the pericardium -- is also an option.

Complementary and Alternative Therapies

People with pericarditis should be under a doctor's care. DO NOT rely on supplements or herbs alone to treat pericarditis. You may use alternative therapies along with conventional treatments, but only under a doctor's supervision. Your doctor needs to find out what's causing the inflammation to treat it properly. Be sure to let your doctors know about the alternative treatments and supplements you may be using or considering using.

Nutrition and Supplements

Your provider may recommend a low-salt diet if you have constrictive pericarditis.

Avoid saturated fats, alcohol, and sugars, which can increase inflammation and weaken your immune system.

Although there are no nutritional supplements that specifically treat pericarditis, the following nutritional supplements may strengthen your immune system and your heart health:

• Coenzyme Q10 (C0Q10). An antioxidant that is good for heart health. CoQ10 can make blood thinners -- such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin -- less effective.
• Vitamin E and vitamin C. Antioxidants that may promote heart health, although evidence is mixed. Vitamin E can increase the risk of bleeding, especially if you already take blood thinners. Vitamin E may interact with a number of medications, so ask your doctor before taking it.
• Magnesium. Helps your heart work efficiently. Magnesium interacts with many medications, herbs, and supplements, and may lower blood pressure. Talk to your doctor before taking magnesium. DO NOT take magnesium if you have kidney damage.
• Bromelain. An enzyme derived from pineapple. It helps fight inflammation and may increase the effectiveness of antibiotic therapy. Bromelain can increase the risk of bleeding, so ask your doctor before taking bromelain if you also take blood thinners or NSAIDs. People with stomach ulcers should avoid bromelain. If taken with antibiotics, bromelain may increase the levels of antibiotic in the body, which could be dangerous.
• Fish oil helps lower inflammation over time. Fish oil can increase the risk of bleeding, so ask your doctor before taking fish oil if you also take blood thinners.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (such as capsules, powders, and teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

Although there are no herbs that specifically treat pericarditis, some may strengthen your immune system and your heart health. Take these herbs only under your doctor's supervision.

For heart support:

• Hawthorn (Crataegus monogyna). Hawthorn has been used traditionally to treat heart problems. However, it has not been studied for pericarditis. Hawthorn interacts with many drugs taken to treat heart disease, high blood pressure, and heart failure.
• Garlic (Allium sativum). Garlic interacts with many medications and may increase the effect of blood-thinning medications, such as warfarin (Coumadin), as well as some medications used to treat HIV. Ask your doctor before taking garlic if you also take blood thinners or any other medications.

To strengthen the immune system short term:

• Echinacea (Echinacea spp.). People with autoimmune disease, such as lupus or rheumatoid arthritis, should not take echinacea. If you have plant allergies, be careful about taking echinacea. Echinacea can interact with several medications. Ask your doctor before taking it.
• Goldenseal (Hydrastis canadensis); often used with echinacea. Goldenseal interacts with many medications, including blood thinners. It may also lower blood sugar. Ask your doctor before taking goldenseal if you take any other medication or if you have diabetes.
• Andrographis (Andrographis paniculata). Andrographis may increase the risk of bleeding, especially if you also take blood thinners. Andrographis may also interact with medications for high blood pressure. People with autoimmune diseases should not take andrographis. People with fertility problems should not take andrographis except under their doctor's supervision.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Some of the most common remedies used for pericarditis are listed below. The common dose is 3 to 5 pellets of a 12X - 30C remedy every 1 to 4 hours until your symptoms improve.

• Aconite. For sudden, sharp pains accompanied by anxiety (especially fear of dying) and restlessness.
• Spongia tosta. For the sensation that the chest will explode, anxiety, light headedness, sweating; patient may be flushed.
• Cactus grandiflorus. For the feeling that there is a band around the chest or a great weight on the chest, or palpitations, or if your condition feels better in the open air and worse at night.

Following Up

Most cases of pericarditis resolve within 3 weeks.

Your doctor may order a follow-up x-ray or electrocardiogram.

Supporting Research

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Cantarini L, Imazio M, Brizi MG, et al. Role of autoimmunity and autoinflammation in the pathogenesis of idiopathic recurrent pericarditis. Clin Rev Allergy Immunol. 2013;44(1):6-13.

Chowdhury UK, Subramaniam GK, Kumar AS, et al. Pericardiectomy for constrictive pericarditis: A clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg. 2006;81(2):522-9.

Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Med. 2004;70:293-8.

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Imazio M, Brucato A, Forno D, et al. Efficacy and safety of colchicine for pericarditis prevention. Systematic review and meta-analysis. Heart. 2012;98(14):1078-82.

Imazio M, Gaita F, LeWinter M. Evaluation and treatment of pericarditis: A systematic review. JAMA. 2015;314(14):1498-506.

Khandaker MH, Schaff HV, Greason KL, et al. Pericardiectomy vs medical management in patients with relapsing pericarditis. Mayo Clin Proc. 2012;87(11):1062-70.

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Pawlak-Cielik A, Szturmowicz M, Fijakowska A, et al. Neoplastic pericarditis: The role of different diagnostic procedures. Pol Arch Med Wewn. 2006;115(1):37-44.

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Review Date: 4/27/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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