American Medical Association Family Medical Guide - American Medical Association [352]
Diagnosis
After examining you, your doctor will probably order diagnostic tests such as a chest X-ray; an echocardiogram (see page 561), an ultrasound examination of the heart; an electrocardiogram (ECG; see page 559), a recording of the electrical activity of the heart; or blood tests. The doctor may insert a needle into your chest to remove some of the fluid for examination in a laboratory. These tests will help determine if you have acute pericarditis and, if you do, will help determine the cause of the inflammation.
Treatment
Acute pericarditis caused by a viral infection usually clears up without treatment. If the pain is severe, the doctor will probably prescribe a nonsteroidal anti-inflammatory drug such as aspirin, ibuprofen, or indomethacin. The doctor may insert a needle into the chest to remove some of the fluid and relieve pressure on the heart.
The inflammation usually subsides within 10 to 14 days and leaves no aftereffects. In rare cases, such as when acute pericarditis occurs a few weeks after a heart attack, a doctor may prescribe a corticosteroid drug to reduce inflammation. When acute pericarditis results from a connective tissue disorder or a metabolic disorder, the underlying disease must be treated.
Constrictive Pericarditis
Pericarditis is inflammation of the pericardium, the membrane that surrounds the heart. The course of constrictive pericarditis is different from that of acute pericarditis (see previous article). Constrictive pericarditis results from long-term inflammation, frequently of unknown cause, but sometimes from a chronic infection such as tuberculosis (see page 663) or from radiation therapy (see page 565), which can thicken, scar, and shrink the pericardium until the heart cannot fill with blood normally. Because tuberculosis is no longer widespread and radiation techniques have improved, constrictive pericarditis is not common.
Symptoms
The main symptoms of constrictive pericarditis are swollen legs and a swollen abdomen caused by fluid accumulation in those areas. Symptoms of heart failure (see page 570) such as shortness of breath and fatigue may also occur. Without surgical treatment, severe heart failure is likely to develop.
Diagnosis
If you have symptoms of heart failure, your doctor will probably recommend diagnostic tests such as a chest X-ray; an echocardiogram (see page 561), an ultrasound examination of the heart; and an electrocardiogram (ECG; see page 559), a recording of the electrical activity of the heart. Your doctor may also recommend cardiac catheterization (see page 592), a procedure to measure the pressure in the arteries and ventricles and to check for possible underlying diseases. The doctor may also order a CT scan (see page 562) or an MRI (see page 113) to evaluate the thickness of the pericardium. He or she will probably order tests of the skin and of phlegm to rule out tuberculosis.
Location of constrictive pericarditis pain
Treatment
Constrictive pericarditis can be treated with a surgical procedure called pericardectomy. In this procedure, the surgeon carefully removes the thickened pericardium from the surface of the heart, which relieves the symptoms significantly.
Disorders of the Circulation
Blood follows two distinct circuits as it flows through the body. In the longer circuit (called the systemic circulation), the heart pumps oxygen-rich blood throughout the body to supply the tissues with oxygen and nutrients and to pick up carbon dioxide and other waste products. In the shorter circuit (called the pulmonary circulation), the heart pumps oxygen-depleted blood through the lungs to receive a fresh supply of oxygen and discard carbon dioxide. The blood then returns to the heart, and the cycle begins again.
The arteries that carry blood away from the heart have thick, muscular walls to absorb the peaks of blood pressure that occur every time the heart beats. The aorta (the main artery in the body) has