• Chest pain:

1. Sharp or stabbing
2. Sudden
3. Worse on breathing in or with movement
4. Radiating to neck, back, shoulders, or abdomen
5. Reduced by sitting up or leaning forward

• Difficulty breathing:

1. Worse with lying down
   Better when standing, sitting, or bent forward
2. Racing Heart
3. Pounding in the Chest
4. Fever
5. Cough
6. Sweating
7. Dizziness
8. Fatigue
9. Loss of appetite

• Idiopathic -- i.e., no cause is identified.  This is the most common type.
• Infections:

1. Viruses -- Coxsackie B (especially children), adenovirus (especially children), Mumps , Epstein-Barr, echo virus, Herpes Simplex
2. Bacteria -- Staphylococcus, Haemophilus (especially children), pneumococcus,
   Salmonella, Lyme Disease, meningococcus, mycoplasma
3. Acute Rheumatic Fever
4. Mycobacterium -- M.Tuberculosis
5. Fungi -- candida, nocardi, Histoplasmosis
6. Parasites

• Drugs:

1. Phenytoin
2. Procainamide
3. Hydralazine
4. Minoxidil

• Others:

1. Cancers:
2. Lung
3. Breast
4. Lymphoma
5. Mesothelioma -- tumors caused by exposure to asbestos

• Connective tissue diseases:

1. Rheumatoid Arthritis
2. SLE ( Systemic Lupus Erythematosus )

• Diseases and other conditions:

• Examination and history
  
• Physician may consult with a heart specialist (cardiologist)
  
• History:

1. Symptoms
2. Medications
3. Illnesses
4. Surgeries
5. Habits
6. Job
7. Family
8. Travel
9. Allergies

• Exam:

• Acute Pericarditis: 
  

1. Patient is in pain and anxious.
   
2. Patient is leaning forward and unable to lie flat.
   
3. Rapid shallow breathing may be present.
   
4. Doctor may hear a friction rub -- (using a  stethoscope) a scratchy noise is heard over the chest, as the two layers of the pericardium rub against each other.
   
5. Listening to the lower back, the doctor may hear Fluid in the Lungs (rales). 
   
6. Pulse rate may speed up and then normalize.
   
7. Fever may be detected.
   

• Pericardial Tamponade:

1. All the same signs or symptoms as with acute Pericarditis
   
2. Patient is pale or with bluish lips (cyanosis)
   
3. Weak or absent pulse
   
4. Rapid, thready pulse rate
   
5. Low or no blood pressure (BP)
   
6. There may be >10 mm Hg drop in systolic BP (the number on top when BP is measured) when the patient breaths in (pulsus paradoxus).
   
7. Putting his hands over the heart, the doctor may feel little activity.
   
8. Lungs may be clear when listened to.
   
9. There may be friction rub.
   
10. There may be muffled or distant heart sounds, Low BP, and distended neck veins (jugular veins) known as Beck's triad.
    

• Constrictive Pericarditis:

1. Often a history of acute Pericarditis or viral illness
   
2. Shortness of breath (dyspnea)
   
3. Fatigue.
   
4. Listening to the lungs one may hear rales.
   
5. Listening to the heart, one may hear an abnormal sound known as a knock. 
   
6. Swollen ankles, legs, arms, and abdomen
   
7. Distended jugular veins
   
8. Kussmaul's sign -- upon inspiration, the pressure in the jugular veins increase and distend the veins.
   

• Tests: 

• Mild cases -- outpatient treatment:

1. Rest
2. Aspirin or other nonsteroidal anti-inflammatory drugs (i.e., NSAIDS such as Motrin, Indocin, etc.) for 2 weeks.  Side effects include stomach upset, bleeding, and others.
3. Prednisone pills for 2-4 weeks can also be used to reduce inflammation of the pericardium.  Side effects include stomach ulcers and infections.  This medicine cannot be stopped suddenly, but must be tapered.
4. Azothioprine and Phenylbutazone are also used in some cases, but have many side effects.
   

• In-patient therapy is recommended if there are signs of heart problems (shock, Low Blood Pressure, very irregular or rapid heart beat):

1. Monitor patient with serial EKG
2. Drain fluids as soon as possible