The pericardium is a double membrane that covers the heart and can be involved in infective and noninfective disorders (see Figure 2 in the chapter entitled Anatomy of the Heart and Circulation).
A. Causes
1. Easily Recognizable Underlying Diseases
These include post myocardial infarction pericarditis, which occurs within the first four days of infarction and later after several months; renal failure; neoplastic diseases; tuberculosis; septicemia causing purulent pericarditis; endocarditis; myxedema; collagen vascular diseases such as
B. Diagnosis
1. Symptoms and Signs
Pericarditis may cause severe chest pain that is located in the retrosternal or left precordial area. Occasionally pain radiates to the trapezius ridge, a radiation that does not occur with angina, but pain may radiate to the neck or left arm and may stimulate angina or myocardial infarction. At times pain is localized to the upper epigastrium and left upper quadrant. Typical features of pain include a sharp, pleuritic pain that increases with deep inspiration, coughing, sneezing, or worsening of pain when lying down. The sharp pain that occurs in bed typically is relieved immediately by sitting and leaning forward or on standing; pain recurs with recumbency.

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