heart doctors in Doddaballapur Road, Bangalore • Pericarditis Inflammation of the pericardial sac may occur as a result of scores of conditions.20 The principal causes of acute pericarditis, where chest pain has to be differentiated from ischaemia, are as follows: 1 infection: viral or bacterial, or associated with pneumonia and severe systemic symptoms, or as a complication of HIV infection or superinfection (e.g. mycobacterial) 2 systemic inflammatory disease: such as rheumatoid arthritis or systemic lupus erythematosus 3 myocardial infarction (epistenocardiac pericarditis, 4 Dressler’s syndrome (after some delay following an infarct or cardiac surgery) 5 uraemia 6 malignancy (not often presenting as chest pain) or radiotherapy. A large group, resembling acute viral pericarditis clinically, remains idiopathic. Symptoms The inflammation causes chest pain that can be difficult to distinguish from that of myocardial infarction but that tends to have a number of distinct features. There may be symptoms of a viral illness or of a connective tissue disease. Pericardial pain is usually pleuritic ; that is, it is worse with respiratory movements. This is because breathing, especially deep breathing, causes the inflamed pericardial surfaces to rub together. Oddly enough, the pain is practically never pulsatile—in keeping with the heart beat. Patients with pericarditis are often more comfortable if they sit up and lean forward. The pain is usually central or left-sided, especially in those with associated pleurisy. Trapezius ridge radiation is highly characteristic of pericarditis; it does not occur in ischaemia. There may be some dyspnoea, which is at least partly a result of the discomfort of breathing.