BACKGROUND:  The pericardium, also called heart sac (theca cordis), is a fibroserous sac that surrounds the heart and the roots of the great vessels. It consists of the serous pericardium and the fibrous pericardium. The serous pericardium consists of the parietal layer, which lines the inside of the fibrous pericardium, and the visceral layer, which adheres to the surface of the heart. Between the two layers is the pericardial space, which contains a few drops of pericardial fluid to lubricate opposing surfaces of the space and allow the heart to move easily during contraction. The fibrous pericardium, which constitutes the outermost sac and is composed of tough, white fibrous tissue lined by the parietal layer of the serous pericardium, fits loosely around the heart and attaches to large blood vessels emerging from the top of the heart but not to the heart itself. It is relatively inelastic and protects the heart and the serous membranes. (Source:

Pericarditis is a swelling and irritation of the pericardium and often causes chest pain and sometimes other symptoms. Pericarditis is usually sudden and short-lived (acute). It is usually caused by trauma, viral infection, bacterial infection, rheumatoid arthritis, and lupus.


SIGNS: Injury or disease may cause fluid to accumulate in the space, causing a wide separation between the heart and the outer pericardium. If pericardial fluid or pus accumulates in the pericardial space, the fibrous pericardium cannot stretch, causing a rapid increase of pressure around the heart. The symptoms may be similar to a heart attack and include chest pain and abnormal heart rhythms. (Source: Mayo Clinic)

TREATMENT:  Your treatment choice for pericarditis depends on the cause as well as the severity. Mild cases of pericarditis may get better on their own without treatment. Medications to reduce the inflammation and swelling associated with pericarditis are often prescribed, including: over-the-counter pain relievers, narcotic pain relievers, colchicine (colcrys), corticosteroids. You'll likely need hospitalization if your doctor suspects cardiac tamponade, a dangerous complication of pericarditis due to fluid buildup around the heart. When cardiac tamponade is present, you may need a procedure called pericardiocentesis.

PARTIAL AND TOTAL PERICARDIECTOMY:  In some cases of severe, recurrent pericarditis, your doctor might suggest surgically removing your pericardium (pericardiectomy). Pericardiocentesis is a procedure where a doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You'll receive a local anesthetic before undergoing pericardiocentesis, which is often done with echocardiogram monitoring and ultrasound guidance. This drainage may continue for several days during the course of your hospitalization. If you're diagnosed with constrictive pericarditis, you may need to undergo a surgical procedure (pericardiectomy) to remove the entire pericardium that has become rigid and is making it hard for your heart to pump. (Source: Mayo Clinic). A partial pericadiectomy can reduce recovery time from two months to three weeks.

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Andrea Pacetti
Cleveland Clinic

(216) 444-8168

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