Pericarditis

Medical Malpractice and Pericarditis: Understanding the Risks of Misdiagnosis and Negligence

Pericarditis is a serious inflammatory heart condition that requires swift clinical recognition and appropriate management. Because its primary symptom—acute chest pain—frequently mimics other severe events like a myocardial infarction (heart attack), a doctor following the standard of care is necessary. When doctors fail to recognize, properly test for, or correctly treat pericarditis, the clinical fallout can be severe, paving the way for medical malpractice and even wrongful death claims.

Anatomy of the Pericardium

To understand pericarditis, one must first understand the anatomy of the heart’s outer structural layer. The heart is in a double walled sac, the pericardium.

• The Fibrous Pericardium: The tough, outer connective tissue layer that anchors the heart within the thoracic cavity and prevents it from filling with too much blood.
• The Serous Pericardium: The delicate inner layer, which has the parietal layer (lining the inside of the fibrous sac) and the visceral layer (also the epicardium, which adheres directly to the heart muscle).
• The Pericardial Cavity: A tiny space between the parietal and visceral layers containing a thin film of serous fluid (typically 15 to 50 mL). This fluid acts as a lubricant, reducing friction as the heart beats.

Pericarditis occurs when these serous layers become inflamed, rubbing against one another like sandpaper and causing severe pain and lack of comfort.

Causes, Risk Factors, and Symptoms – Pericarditis Medical Malpractice

Causes

The vast majority of acute pericarditis cases do not have a specific root cause that can be identified. However, known causes include:

• Viral Infections: Often happening after a respiratory or gastrointestinal illness (e.g., Coxsackievirus, influenza, and COVID-19).
• Bacterial or Fungal Infections: Less common but highly severe (e.g., tuberculosis).
• Systemic Autoimmune Disorders: Lupus, rheumatoid arthritis, or scleroderma.
• Post-Cardiac Injury: Damage from a heart attack, cardiac surgery, or thoracic trauma.
• Metabolic/Other Factors: Kidney failure (uremic pericarditis) or certain metastatic cancers.

Risk Factors

Individuals at higher risk include men aged 20 to 50, patients with a history of recent viral infections, individuals suffering from autoimmune diseases, and patients after recent cardiac procedures or chest trauma.

Symptoms

The clinical presentation of pericarditis is distinct but easily confused with other chest conditions. Symptoms include:

• Sharp, stabbing chest pain: Usually felt behind the breastbone or on the left side of the chest.
• Positional relief: The pain typically worsens when breathing in deeply (pleuritic pain) or lying flat, and often improves when sitting up and leaning forward.
• Pericardial friction rub: A scratching or creaking sound heard through a stethoscope.
• Secondary signs: Low-grade fever, shortness of breath (dyspnea), palpitations, and a dry cough.

Diagnosis: Providers, Tests, and Clinical Findings – Pericarditis Medical Malpractice

Medical Providers for Diagnosis

When a patient presents with symptoms, the process usually begins with an emergency medicine physician, a primary care provider (PCP), or an urgent care provider. Once a cardiac anomaly is suspected, the patient is referred to a cardiologist for a urgent diagnosis.

Diagnostic Tests and Findings

To secure a diagnosis, medical providers look for at least two of the four primary diagnosis criteria (chest pain, friction rub, specific EKG changes, or new pericardial effusion or one that is getting worse):

Treatment, Providers, and Prognosis – Pericarditis Medical Malpractice

Medical Providers for Treatment

A cardiologist primarily manages the ongoing care of pericarditis. If the case is rooted in an autoimmune condition, a rheumatologist is seen. In advanced, complicated cases where fluid must be drained or the sac removed, a cardiac surgeon or thoracic surgeon is required.

Treatments

• First-Line Medications: High-dose Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like ibuprofen or aspirin, paired with Colchicine to reduce inflammation and reduce the risk of a recurrence.
• Corticosteroids: Steroids given only if NSAIDs fail or are contraindicated, as use too soon can increase recurrence rates.
• Pericardiocentesis: An invasive procedure using a needle to drain excess fluid if the effusion threatens cardiac function.
• Pericardiectomy: Surgical removal of the pericardium, reserved for chronic, constrictive pericarditis.

Prognosis

For most patients, the prognosis for acute pericarditis is excellent, with full recovery occurring within a few weeks to a few months. However, roughly 15% to 30% of patients experience recurrent pericarditis. If untreated, it can transition into constrictive pericarditis—where the sac permanently thickens and scars, constricting the heart’s chambers—or lead to cardiac tamponade, a lethal emergency where excess fluid prevents the heart from filling with blood.

Pericarditis and Medical Malpractice Claims

In the legal arena, medical malpractice claims surrounding pericarditis generally center on a provider’s failure to adhere to the medical standard of care, leading to severe injury or death. These claims usually fall into three distinct buckets:

1. Failure to Diagnose / Misdiagnosis

Pericarditis can be challenging to isolate because its presentation is not specific; in fact, studies show up to 35% of patients are initially misdiagnosed. Malpractice claims frequently arise when a physician completely misses the condition, misinterprets an EKG, or misdiagnoses the chest pain as a harmless musculoskeletal strain or anxiety. If the provider fails to order an echocardiogram or blood work when a friction rub or pleuritic chest pain is present, they may be liable for the patient’s subsequent deterioration.

Conversely, relying blindly on false-positive troponin assays without looking at the broader clinical picture can lead to dangerous failure to diagnose myopericarditis, subjecting patients to unnecessary, invasive cardiac interventions.

2. Failure to Treat and Prevent Fatal Complications

Even if there is a diagnosis, a failure to initiate first therapies (like proper dosing of NSAIDs and colchicine) or a failure to schedule continuous follow-ups can constitute malpractice. If a physician notices a pericardial effusion that get worse on an echocardiogram but fails to monitor the patient for signs of cardiac tamponade, they can be legally responsible if the patient suffers obstructive shock or cardiac arrest.

3. Iatrogenic (Doctor-Caused) Pericarditis or Tamponade

Medical malpractice claims can also arise from surgical errors committed during medical procedures. Iatrogenic cardiac injury is an injury in heart surgeries and interventions like placing pacemakers, cardiac catheterizations, and valve replacements. If a surgeon accidentally perforates a coronary vessel or punctures the pericardium due to malpractice in technique, causing an iatrogenic cardiac tamponade, this can serve as the foundation of a successful medical malpractice lawsuit.

Pericarditis & Medical Malpractice

You can read a Baltimore Medical Malpractice Lawyer Blog post on a case involving a related condition, Chest Effusion $25M, and also posts on other case Verdicts.

If you have been injured in connection with pericarditis, contact us today.

Visit our free consultation page or video. Then contact the Kopec Law Firm at 800-604-0704 to speak directly with Attorney Mark Kopec. He is a top-rated Baltimore medical malpractice lawyer. The Kopec Law Firm is in Baltimore and pursues cases throughout Maryland and Washington, D.C.