Pericarditis

Pericarditis is an inflammation of the pericardium a sac surrounding the heart. The most common form is acute pericarditis which can usually be treated without hospitalization. Common in adolescents and young adults acute pericarditis affects males more than females. Pericardial effusion is a form that results when fluid builds up in the pericardium. It is a more serious condition that can require hospitalization and possibly surgery. Constrictive pericarditis is a form that is a chronic condition and worsens gradually over a long period of time. It may ultimately require surgery. Pericardial effusion and constrictive pericarditis can occur together.

Signs and Symptoms

The signs and symptoms of pericarditis vary somewhat.

Acute pericarditis:

• Chest pain
• Fever
• Flushed appearance
• Muscle pain
• Pain with swallowing
• Feelings of anxiousness discomfort or uneasiness

Pericardial effusion:

• Difficulty breathing
• A bluish skin color

Constrictive pericarditis:

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

What Causes It?

Acute pericarditis and pericardial effusion have a large number of possible causes 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. Constrictive pericarditis usually results from repeated cases of acute pericarditis.

What to Expect at Your Provider's Office

Your health care provider will listen to your heart and lungs take your pulse and probably tap your chest and back. Your provider will probably order a number of tests which may include blood work an electrocardiogram an echocardiogram chest X-ray computed tomography (CT) scan or magnetic resonance imaging (MRI).

Treatment Options

Treatment Plan

Your health care provider will give you aspirin or nonsteroidal anti-inflammatory drugs to reduce the inflammation. For more severe cases corticosteroids are used to reduce inflammation. You will probably be in the hospital until the cause of your pericarditis is known or until you are stable. More severe and chronic cases require surgery.

Drug Therapies

Prescription

• Nonsteroidal anti-inflammatory drugs—such as indomethacin; reduces inflammation; various side effects
• Colchicine—reduces inflammation; various side effects
• Corticosteroids—such as azathioprine or prednisone; for more severe cases reduces inflammation; various side effects

Over the Counter

• Aspirin—reduces inflammation; various side effects; do not give to children under 18 years as it can cause Reye's syndrome
• Ibuprofen—reduces inflammation; various side effects

Complementary and Alternative Therapies

Alternative therapies may have benefit as supportive treatments for some of the causes of pericarditis. Hawthorn (Crataegus oxycantha) is a cardiac tonic with very low toxicity that could be used along with whatever therapy your provider deems most appropriate.

Nutrition

• Vitamin C (1 000 mg three times per day) may help decrease inflammation. It also aids in fighting infection and is an antioxidant.
• Coenzyme Q10(50 mg bid) is an important antioxidant that may help prevent heart muscle damage and speed recovery.
• Your provider may recommend sodium restriction if you have constrictive pericarditis.
• If your pericarditis is of viral origin your provider may recommend supplementation with vitamin A (300 000 IU/day for 3 days).
• Flaxseed oil (3 g twice per day) helps decrease inflammation.
• Avoid saturated fats alcohol and sugars which can lead to increased inflammation and lowered immune function.
• Consume at least five servings of fruits and vegetables per day. These foods are anti-inflammatory and protect the heart.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. 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.

• Hawthorn (Crataegus oxyanthoides) can help prevent high blood pressure and hardening of the arteries. Dose is 60 drops tincture three times per day 1 tsp. berries steeped for 10 minutes in hot water or 100 to 250 mg three times per day as a supplement.
• Linden (Tilea europea) is used for high blood pressure with nervous tension and may be useful adjunctive treatment where there is anxiety. Dose is 1 tsp. dried blossoms per cup hot water three times a day or 60 drops tincture three times a day.
• Blue monkshood (Aconitum napellus) has been described as an herbal remedy for pericarditis without significant effusion. CAUTION: As this herb can be highly toxic even fatal it is not recommended unless prescribed by an experienced health care provider.

Homeopathy

Some of the most common remedies used for pericarditis are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• 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; palpitations; feels better in the open air and worse at night

Acupuncture

Can be very helpful in decreasing inflammation enhancing immune response and regulating cardiac function.

Following Up

Your provider may order a follow-up X-ray or electrocardiogram.

Supporting Research

Andreoli TE Bennett JC Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia Pa: WB Saunders; 1993:110–114.

Dambro MR. Griffith's 5-Minute Clinical Consult–1999. Baltimore Md: Lippincott Williams & Wilkins; 1999:792–793.

Fleming T Gruenwald J Brendler T Jaenicke C eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998:606–608.

Stein JK ed. Internal Medicine. 4th ed. St. Louis Mo: Mosby-Year Book; 1994:248–252.

Stoller JK Ahmad M Longworth DL eds. The Cleveland Clinic Intensive Review of Internal Medicine. Baltimore Md: Williams & Wilkins; 1998:759–760.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.