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Pericarditis

Also listed as: Heart infection - pericarditis

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Supporting Research

Pericarditis is a swelling and inflammation of the pericardium, a sac surrounding your heart. Pericarditis can be sudden or long-term. The most common form is acute pericarditis, which can usually be treated without hospitalization. In mild cases, the condition may improve on its own, while more severe cases may require medication and surgery. Complications can include cardiac tamponade, which results when fluid builds up in the pericardium. It is a more serious condition that can require hospitalization and possibly surgery. Another complication is constrictive pericarditis, which results from chronic pericarditis that causes scarring and thickening of the pericardium. It, too, may ultimately require surgery. Pericardial effusion and constrictive pericarditis can occur together.

Signs and Symptoms

The signs and symptoms of pericarditis vary, but the most common is chest pain.

Acute pericarditis:

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

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 (chronic) 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. They will probably order several tests, which may include blood work, an electrocardiogram (ECG), an echocardiogram, chest x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI).

Treatment Options

Pericarditis is usually treated with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen), but the doctor may prescribe corticosteroid medicines. If a bacterial infection is present, you will be given antibiotics. If you develop cardiac tamponade, your doctor may recommend a procedure called pericardiocentesis, which involves draining fluid from your chest.

Complementary and Alternative Therapies

People with pericarditis should be under the care of a physician. Alternative therapies can be used as supportive treatments for some of the causes and symptoms of pericarditis, but it is important to determine the cause of the inflammation to treat it properly. Hawthorn (Crataegus monogyna) is a cardiac tonic with very low toxicity that could be used along with most therapies that your provider deems most appropriate. Still, it is important to keep all your providers informed about all the alternative treatments and supplements you may be using.

Nutrition and Supplements

• To support immune function, include vitamins C (1,000 mg up to three times per day, or a lower dose if diarrhea develops), E (400 - 800 IU per day), A (10,000 IU per day) or beta-carotene (100,000 IU per day), plus selenium (200 mcg per day), and zinc (30 mg per day).
• Coenzyme Q10 (100 mg twice a day) protects the heart.
• Magnesium (200 - 500 mg two to three times per day) for normal cardiac function. Do not take if you have kidney damage and consult your doctor because magnesium can interact with certain medications, such as calcium channel blockers.
• Bromelain (250 - 500 mg three times per day between meals) helps fight inflammation and may increase the effectiveness of antibiotic therapy.
• Your provider may recommend a low-salt diet if you have constrictive pericarditis.
• Fish oil (1.5 g two times per day) helps decrease inflammation over time. Be cautious if you are taking aspirin or blood-thinning medications because fish oil can also thin the blood.
• Avoid saturated fats, alcohol, and sugars, which can lead to increased inflammation and lowered immune function.

Herbs

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

Take these herbs only under your doctor's supervision. For heart support:

• Hawthorn ( Crataegus monogyna), 240 - 600 mg per day
• Motherwort (Leonurus cardiaca), 2 g or 1 cup tea two or three times per day. To make tea, steep 2 g in one cup boiling water. Strain and cool
• Linden ( Tilia cordata ), 1 - 2 cups tea per day. To make tea, steep 2 g in one cup boiling water. Strain and cool
• Asian ginseng ( Panax ginseng ), 200 - 600 mg per day
• Garlic ( Allium sativum ), 600 - 900 mg per day

For immune system support:

• Coneflower ( Echinacea spp .), 500 - 1,000 mg three times per day
• Goldenseal ( Hydrastis canadensis), 500 - 1,000 mg three times per day; often used with coneflower
• Wild indigo ( Baptisia tinctoria ), 1 cup of tea three times per day. To make tea, steep 500 -1,000 mg dried root in one cup boiling water. Strain and cool.
• Andrographis ( Andrographis paniculata) , 400 mg three times per day

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- 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. Usually, the dose is three to five pellets of a 12X to 30C remedy every 1 - 4 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, or palpitations,or if your condition feels better in the open air and worse at night

Acupuncture

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

Following Up

Your health care 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 Co; 1993:110-114.

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.

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

Gruenwald J, Brendler T, Jaenicke C, eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:606-608.

Ivanovska N, Philipov S. Study on the anti-inflammatory action of Berberis vulgaris root extract, alkaloid fractions and pure alkaloids. Int J Immunopharmac. 1996;18(10):553-561.

Snow JM. Hydrastis canadensis L. (Ranunculaceae). Protocol J Botan Med. 1997;2:25-28.

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.

Zapfe jun G. Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II. Phytomedicine . 2001;8:262-6.

• Review Date: 9/1/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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