Pericarditis

Pericarditis is swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium). Pericarditis often causes sharp chest pain. The chest pain occurs when the irritated layers of the pericardium rub against each other.

Pericarditis is usually mild and goes away without treatment. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help reduce the risk of long-term complications from pericarditis.

Symptoms

Chest pain is the most common symptom of pericarditis. It usually feels sharp or stabbing. However, some people have dull, achy or pressure-like chest pain.

Pericarditis pain usually occurs behind the breastbone or on the left side of the chest. The pain may:

• Spread to the left shoulder and neck
• Get worse when coughing, lying down or taking a deep breath
• Get better when sitting up or leaning forward

Other signs and symptoms of pericarditis may include:

• Cough
• Fatigue or general feeling of weakness or being sick
• Leg swelling
• Low-grade fever
• Pounding or racing heartbeat (heart palpitations)
• Shortness of breath when lying down
• Swelling of the belly (abdomen)

The specific symptoms depend on the type of pericarditis. Pericarditis is grouped into different categories, according to the pattern of symptoms and how long symptoms last.

• Acute pericarditis begins suddenly but doesn't last longer than three weeks. Future episodes can occur. It may be difficult to tell the difference between acute pericarditis and pain due to a heart attack.
• Recurrent pericarditis occurs about four to six weeks after an episode of acute pericarditis with no symptoms in between.
• Incessant pericarditis lasts about four to six weeks but less than three months. The symptoms are continuous.
• Chronic constrictive pericarditis usually develops slowly and lasts longer than three months.

When to see a doctor

Seek immediate medical care if you develop new symptoms of chest pain.

Many of the symptoms of pericarditis are similar to those of other heart and lung conditions. It's important to be thoroughly evaluated by a health care provider if you have any type of chest pain.

Causes

The cause of pericarditis is often hard to determine. A cause may not be found (idiopathic pericarditis).

Pericarditis causes can include:

• Immune system response after heart damage due to a heart attack or heart surgery (Dressler syndrome, also called postmyocardial infarction syndrome or postcardiac injury syndrome)
• Infection, such as COVID-19
• Inflammatory disorders, including lupus and rheumatoid arthritis
• Injury to the heart or chest
• Other chronic health conditions, including kidney failure and cancer

Complications

Early diagnosis and treatment of pericarditis usually reduces the risk of complications. Potential complications of pericarditis include:

• Fluid buildup around the heart (pericardial effusion). The fluid buildup can lead to further heart complications.
• Thickening and scarring of the heart lining (constrictive pericarditis). Some people with long-term pericarditis develop permanent thickening and scarring of the pericardium. The changes prevent the heart from filling and emptying properly. This unusual complication often leads to severe swelling of the legs and abdomen and shortness of breath.
• Pressure on the heart due to fluid buildup (cardiac tamponade). This life-threatening condition prevents the heart from filling properly. Less blood leaves the heart, causing a dramatic drop in blood pressure. Cardiac tamponade requires emergency treatment.

Prevention

There's no specific prevention for pericarditis. However, taking these steps to prevent infections might help reduce the risk of heart inflammation:

• Avoid people who have a viral or flu-like illness until they've recovered. If you're sick with symptoms of a viral infection, try to avoid exposing others.
• Follow good hygiene. Regular hand-washing can help prevent spreading illness.
• Get recommended vaccines. Stay up to date on the recommended vaccines, including those that protect against COVID-19, rubella and influenza — diseases that can cause myocarditis. Rarely, the COVID-19 vaccine can cause inflammation of the outer heart lining (pericarditis) and inflammation of the heart muscle, especially in males ages 12 through 17. Talk to your health care provider about the benefits and risks of vaccines.

Diagnosis

To diagnose pericarditis, a health care provider will usually examine you and ask questions about your symptoms and medical history.

A stethoscope is typically placed on the chest and back to listen to heart sounds. Pericarditis causes a specific sound, called a pericardial rub. The noise occurs when the two layers of the sac surrounding the heart (pericardium) rub against each other.

Blood tests are usually done to check for signs of a heart attack, inflammation and infection. Other tests used to diagnose pericarditis may include:

• Electrocardiogram (ECG). An electrocardiogram is a quick and painless test that records the electrical signals in the heart. Sticky patches (electrodes) with wires attached connect to a monitor. They record the electrical signals that make the heart beat. A computer records the information and displays it as waves on a monitor or on paper.
• Chest X-ray. A chest X-ray can show changes in the size and shape of the heart. It can help detect an enlarged heart.
• Echocardiogram. Sound waves (ultrasound) create images of the moving heart. An echocardiogram can show how well the heart is pumping blood and if there is fluid buildup in the tissue surrounding the heart.
• Cardiac computerized tomography (CT) scan. Cardiac CT scans use X-rays to create images of the heart and chest. The test can be used to look for heart thickening that may be a sign of constrictive pericarditis.
• Cardiac magnetic resonance imaging (MRI). Cardiac MRI uses a magnetic field and radio waves to create cross-sectional images of the heart. A cardiac MRI scan can reveal thickening, inflammation or other changes in the thin tissue surrounding the heart.

Treatment

Treatment for pericarditis depends on the cause and the severity of the symptoms. Mild pericarditis may get better without treatment.

Medications

Medications to reduce the inflammation and swelling are often prescribed. Examples include:

• Pain relievers. Pericarditis pain can usually be treated with over-the-counter pain relievers, such as aspirin or ibuprofen (Advil, Motrin IB, others). Prescription-strength pain relievers also may be used.
• Colchicine (Colcrys, Mitigare). This drug reduces inflammation in the body. It's used to treat acute pericarditis or if symptoms tend to come back. You should not take this drug if you have liver or kidney disease. Colchicine can also interfere with other drugs. Your health care provider will carefully check your health history before prescribing colchicine.
• Corticosteroids. Corticosteroids are strong medications that fight inflammation. A corticosteroid such as prednisone may be prescribed if pericarditis symptoms don't get better with other medications, or if symptoms keep returning.

If pericarditis is caused by a bacterial infection, treatment may include antibiotics and drainage, if necessary.

Surgeries or other procedures

If pericarditis causes fluid buildup around the heart, a surgery or other procedure may be needed to drain the fluid.

Surgeries or other procedures to treat pericarditis include:

• Pericardiocentesis. In this procedure, a sterile needle or a small tube (catheter) is used to remove and drain the excess fluid from the pericardial cavity.
• Removal of the pericardium (pericardiectomy). The entire pericardium may need to be removed if the sac surrounding the heart is permanently rigid due to constrictive pericarditis.

Lifestyle and home remedies

For mild pericarditis, rest and over-the-counter pain medications — taken as directed by your care provider — may be all that's needed.

While you recover, avoid strenuous physical activity and competitive sports. Such activity can trigger pericarditis symptoms. Ask your health care provider how long you need to rest.

Preparing for an appointment

You're likely to start by seeing a primary care provider or an emergency room doctor. You may be referred to a doctor trained in heart conditions (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

When you make your appointment, ask if you need to do anything in advance, such as restrict your diet.

Write down the following information and take it with you to the appointment:

• Write down any symptoms you're having and for how long. Also note if you've had similar symptoms that have come and gone in the past.
• Make a list of your key medical information, including other recent health concerns you've had and the names of any prescription and over-the-counter medications you're taking.
• Ask a family member or friend to come with you to the appointment, if possible. Someone who goes with you can help remember what the health care provider says.
• Write down the questions you want to be sure to ask your health care provider.

For pericarditis, some basic questions to ask your health care provider include:

• What's the most likely cause of my symptoms?
• What kinds of tests do I need? Will I need to stay in the hospital for testing?
• What treatment approach do you recommend?
• How soon after I begin treatment can I expect improvement in my symptoms?
• What are the possible side effects of the treatments you're prescribing?
• Am I at risk of long-term complications from this condition?
• How often will I need follow-up appointments for this condition?
• Do I need to follow any activity or diet restrictions?
• Are there any special guidelines for managing this condition along with my other health conditions?

In addition to the questions that you've prepared to ask your health care provider, don't hesitate to ask additional questions that occur to you during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions. Being ready to answer them may save time to go over any points you want to talk about in-depth. Your health care provider may ask:

• Can you describe your symptoms? Where is the pain? How severe is the pain?
• When did your symptoms start?
• Did your symptoms come on slowly or suddenly?
• Have you had similar symptoms in the past?
• Are you having any difficulty breathing?
• Does changing your position affect your pain?
• Have you recently had a cold or the flu? What about a fever?
• Have you recently lost weight without trying?
• Do you have a first-degree relative — parent, sibling or child — with a history of heart disease?
• Do you or did you smoke? How much?

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