Health Encyclopedia

Pericarditis - bacterial

Definition

Bacterial pericarditis is irritation and swelling of the sac that surrounds the heart (pericardium), due to infection by bacteria.

Alternative Names

Purulent pericarditis

Causes, incidence, and risk factors

Bacterial infections are one cause of pericarditis. Since the introduction of antibiotics, bacterial pericarditis has become rare.

It most often occurs in men between the ages of 20 and 50, usually after some type of respiratory infection. It can also occur after skin or mouth infections that produce bacterial infection of the blood (bacteremia) and after heart surgery.

The bacterial infection causes the pericardium to become swollen and inflamed. Pain occurs as a result of the inflamed pericardium rubbing against the heart. Fluid may build up in the pericardial sac.

The most common bacteria that cause this condition are:

Haemophilus influenza (also called H.flu)
Meningococci
Pneumococci
Staphylococci
Streptococci

Symptoms

Anxiety
Chest pain
- May move (radiate) to the neck, shoulder, back or abdomen
- Pain increases with breathing
- Sharp, stabbing
- Sitting up or standing relieves pain
Chills
Difficulty breathing
Dry cough
Fatigue
Fever
Splinting of ribs with deep breathing (bend over and hold chest when breathing)
Sweating

Signs and tests

Signs include:

Faint or far away sounding heart sounds
Rubbing sound heard when listening to the heart through a stethoscope
Septic shock
Signs of fluid in the pericardium (pericardial effusion)
Signs of fluid in the space around the lungs (pleural effusion), such as decreased breath sounds
Signs of pneumonia

Doctors may suspect pericarditis when one of the following tests shows an abnormal amount of fluid in the pericardial sac:

This condition is diagnosed when the fluid around the pericardial sac is shown to be infected with bacteria. The following tests help doctors make this diagnosis:

Treatment

The goal of treatment is to cure the infection.

Medications include:

Antibiotics to treat bacterial infections
Analgesics to relieve pain
Aspirin, ibuprofen, or other nonsteroidal anti-inflammatory medications (NSAIDS) to relieve inflammation of the pericardium
Diuretics to remove excess fluid

Bedrest with the head of the bed raised may reduce the workload on the heart.

Other treatments include:

Cutting a small hole (window) in the pericardium (subxiphoid pericardiotomy) to allow infected fluid to drain
Draining fluid from the pericardial sac (pericardiocentesis) to prevent or treat cardiac tamponade
Pericardial stripping or removing part of the pericardium (surgical pericardiectomy) if bacterial pericarditis is chronic or comes back

Expectations (prognosis)

The disorder may be life-threatening if untreated. The outcome is good if bacterial pericarditis is treated promptly. Most people recover completely with treatment.

Complications

Cardiac tamponade
Constrictive heart failure
Pulmonary edema

References

LeWinter MM. Pericardial Diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 70.

Review Date:5/15/2008
Reviewed By:Alan Berger, MD, Assistant Professor, Divisions of Cardiology and Epidemiology, University of Minnesota, Minneapolis, MN. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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