Pericarditis in Children and Adolescents
Pericarditis is caused by inflammation of the lining around the heart (pericardium), which results in an accumulation of fluid around the heart (pericardial effusion).
What Causes It?
In children, the most common cause of pericarditis is an infection by a virus. Much less frequently it can be caused by other types of infections (bacteria or tuberculosis), disorders of the immune system (such as lupus erythematosis or rheumatoid arthritis), kidney failure, or some types of cancer. A pericardial effusion can also result following heart surgery. In adults, pericarditis is much more frequently due to cancer, kidney failure and immunity problems, and can also follow a heart attack (Dressler's syndrome). Pericarditis can also be part of a more general inflammation of the heart muscle (myopericarditis or myocarditis).
What are the Signs of Pericarditis?
Children with pericarditis usually develop fever and chest pain. The chest pain is generally at the front of the chest behind the breastbone (sternum) and is often described as "stabbing". Usually the pain is worse when laying down, and improved by sitting up and leaning forward. If the amount of fluid that accumulates around the heart increases too much (cardiac tamponade), a child can develop shortness of breath, dizziness or even fainting.
What is the Treatment?
Pericarditis is a medical emergency, as it can be fatal if not treated quickly. A patient that is concerned about pericarditis should immediately be evaluated, at an emergency room if necessary. In the case of a large accumulation of fluid, it may be necessary to drain some fluid out using a small tube (pericardiocentesis). This will provide immediate relief of the symptoms of tamponade, and will provide fluid for testing to determine the cause of the pericarditis. If the amount of fluid is not too great, and the cause is fairly confidently known (such as an effusion after heart surgery), the only treatment may be anti-inflammatory medicines (such as ibuprofen or steroids) and close observation.
What is the Long Term Prognosis?
The long term effects of pericarditis depends quite a bit on the cause. The most common sort of pericarditis, caused by a virus, generally has no known long term problems. Once the patient has recovered, there is no reason to suspect that other problems will arise. In some cases, however, especially with bacterial or tuberculous pericarditis, the lining around the heart can become scarred and tight, making it hard for the heart to fill and pump (constrictive or restrictive pericarditis). In this case, more testing and procedures may be necessary in the future.
Pericarditis in Children:
eMedicine - http://www.emedicine.com/PED/topic2524.htm
Vanderbilt - http://www.mc.vanderbilt.edu/peds/pidl/cardio/pericard.htm
NIH - http://www.nlm.nih.gov/medlineplus/ency/article/000182.htm
Pericarditis in Adults:
eMedicine - http://www.emedicine.com/EMERG/topic412.htm
Iowa Clinic - http://www.iowaclinic.com/adam/ency/article/000182.shtml