Recurrent Pericarditis

What is recurrent pericarditis?

Recurrent pericarditis is when you develop pericarditis for a second time after having no symptoms for at least four weeks.

Pericarditis is an inflamed pericardium, 一种囊状器官，有两层薄薄的组织包围着心脏，使其固定并帮助其工作. 少量的液体使这两层保持分离，并在心脏跳动时减少它们之间的摩擦. 但在一些患有这种疾病的人身上，这些组织会变得肿胀和发炎. 这可能会引起剧烈的胸痛，并可能导致心脏周围的液体积聚，从而引起不适. 在大多数情况下，心包炎是轻微的，无需治疗即可自行好转.

在美国，15%至50%的心包炎患者复发性心包炎.S., or about 40,000 people. 心包炎最常见于16至65岁的男性，但它可以影响任何年龄的任何人. Recurrent pericarditis occurs more frequently in women, 谁更容易受到自身免疫性疾病的影响从而刺激心包. 最近的一项研究发现，在急诊室寻求胸痛治疗的人中，约有5%患有急性心包炎.

Other types of pericarditis include:

• Acute pericarditis (less than four to six weeks)
• 不间断心包炎(持续症状超过4至6周，但治疗后不到3个月)
• 缩窄性心包炎(持续3个月以上，常为慢性) heart failure 组织形成并使心包失去弹性)

Download infographic: Recurrent Pericarditis (PDF)

What are the symptoms of recurrent pericarditis?

Symptoms of recurrent pericarditis include:

• Dull ache, pressure or stabbing pain in the chest that gets worse when coughing, 深呼吸或躺下(有些人误以为是心脏病发作), improved by sitting up and leaning forward
• Shortness of breath or difficulty breathing
• Heart palpitations or a faster than normal heartbeat
• Low-grade fever
• Cough
• Swollen abdomen, legs or feet
• 低血压症状，如头晕、头晕或昏厥

What causes recurrent pericarditis?

While there’s no single cause for recurrent pericarditis, 它通常发生在最初的心包炎没有得到充分治疗的人身上. 长期使用皮质类固醇，如强的松，也可能与复发有关.

In up to 20% of cases, viral illnesses such as herpes, influenza, adenovirus, enterovirus, Epstein Barr virus (EBV), or hepatitis viruses (A, B, C) may also cause recurrent pericarditis.

Other potential causes include:

• 自身免疫性疾病，如狼疮、硬皮病和类风湿性关节炎
• Complications from a heart attack or heart surgery
• 健康问题，如肾衰竭、癌症、艾滋病毒/艾滋病或结核病
• 细菌、真菌和寄生虫感染(最常见于免疫系统受损的人群)
• Certain medications, such as phenytoin (an anti-seizure medicine), warfarin and heparin (blood thinners), and procainamide (prescribed for irregular heartbeats) 

The cause of recurrent pericarditis often can’t be identified.

How is recurrent pericarditis diagnosed?

你的初级保健医生，儿科医生或内科医生经常诊断和治疗复发性心包炎. Depending on your age and medical conditions, a cardiologist or infectious disease specialist may also be involved.

If your doctor believes you may have pericarditis, 他们会听你的心脏摩擦的声音，这种声音经常出现在患有这种疾病的人身上. Doctors may use the following tests to confirm the diagnosis:

• Blood test: May reveal the presence of white blood cells, C-reactive protein and other signs of inflammation. It may also detect signs of heart injury such as troponin.
• EKG (心电图):提供心脏电活动的图像，某些结果可能提示心包炎.
• Chest X-ray: Takes pictures of the heart, lungs and blood vessels inside your chest. x光片能显示心脏是否因心包积液过多而增大. 它也可能显示感染，结节病或恶性肿瘤的迹象，可能导致心包炎.
• Echocardiogram声波可以显示你的心脏的大小、形状和工作原理. This can reveal fluid accumulation in the pericardium.
• Cardiac CT 计算机断层扫描:一种能清晰、详细地拍摄心脏图像的x射线.
• Cardiac MRI (磁共振成像):磁铁和无线电波产生你的器官和组织的详细图像, which can reveal changes in the pericardium.

How is recurrent pericarditis treated?

Recurrent pericarditis is usually treated with aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS). 抗炎药秋水仙碱可以提高这些药物的有效性，并经常与它们一起开处方.

When NSAIDs and colchicine don’t lead to a complete remission, 低至中等剂量的皮质类固醇如强的松也可以开处方. Because steroids have been linked with a higher risk of recurrence, 它们通常用于不能耐受非甾体抗炎药的人、孕妇或患有自身免疫性疾病等疾病的人.

Immunosuppressants and interleukin 1 blockers, which neutralize pro-inflammatory molecules, 也可以开给5%到10%对药物无效的病人.

Your doctor may also drain excess fluid from the pericardium or, as a last result, remove it partially or entirely.

Outlook

对于大多数人来说，复发性心包炎可在家中安全处理，很少导致死亡. 但它可能引起潜在的危及生命的并发症，如心包弹性丧失(缩窄性心包炎)和心包积液(心包填塞)。. Some people with pericarditis may also have pericardial thickening.

如果你有以下症状之一，你的医生可能会让你去医院治疗:

• Fever of 100.4 or higher
• 用消炎药治疗一周后心包炎持续
• Heart damage

如果你感到任何类型的胸痛，立即拨打911，因为这可能是心脏病发作的征兆. If you have recurrent pericarditis, be sure to talk to your doctor about your symptoms and treatment options. 

Download our Answers by Heart Sheet: What is Recurrent Pericarditis? (PDF)