Pericarditis is the inflammation of the pericardium, a thin, two-layered sac that surrounds your heart.
The layers have a small amount of fluid between them to prevent friction when the heart beats. When the layers are inflamed, it can result in chest pain.
The role of the pericardial fluid is to lubricate the heart and the pericardium protect it from infection. The pericardium also helps keep your heart in place inside the chest wall.
Pericarditis is an inflammatory condition, usually acute, coming on suddenly, and lasting a from few days to a few weeks.
The cause of most pericarditis isn’t known, but viral infections are thought to be responsible for
Anything else that causes inflammation, such as cancer, can also cause pericarditis. Certain medications can also be a cause.
Most of the time, pericarditis resolves on its own. However, treatments are available to decrease the duration of the condition and prevent recurrences.
Other inflammatory conditions of the heart are:
- Endocarditis. This involves the inflammation of the endocardium, the inner lining of your heart chambers and valves. It’s usually caused by a bacterial infection.
- Myocarditis. This is the inflammation of the heart muscle, or myocardium. It’s usually caused by a viral infection.
- Myopericarditis. This is an inflammation of the heart muscle and pericardium.
- Acute pericarditis is most common. It may occur on its own or as a symptom of an underlying disease.
- Recurring (or relapsing) pericarditis may be intermittent or constant. The first recurrence is usually within
18 to 20 monthsof the initial attack.
- Pericarditis is considered chronic when a relapse occurs as soon as anti-inflammatory treatment is stopped.
- Pericardial effusion is a buildup of fluid in the pericardium layers.
Almost a thirdof people with large pericardial effusions develop cardiac tamponade, which is a medical emergency.
- Cardiac tamponade is a sudden buildup of fluid in the pericardium layers, which causes your blood pressure to drop and stops your heart from being able to fill. This requires emergency treatment.
- Delayed pericarditis or Dressler syndrome is when pericarditis develops in the weeks after heart surgery or a heart attack.
- Constrictive pericarditis is when the pericardium gets scarred or sticks to the heart so the heart muscle can’t expand. This is rare and can develop in people with chronic pericarditis or after heart surgery.
- Effusive-constrictive pericarditis is when both effusion and constriction are present.
Pericarditis can feel like a heart attack, with a sharp or stabbing pain in your chest that comes on suddenly.
The pain can be in the middle or left side of your chest, behind the breastbone. Pain may radiate to your shoulders, neck, arms, or jaw.
Your symptoms may vary, depending on the type of pericarditis you have.
When you have a sharp chest pain, it’s best to seek medical help right away.
About 85 to 90 percent of people with pericarditis have chest pain as a symptom. Other symptoms include:
- low fever
- weakness or fatigue
- trouble breathing, especially when lying down
- dry cough
- swelling in your feet, legs, and ankles
Your symptoms may worsen when you:
- lie flat
- take deep breaths
Sitting up and leaning forward may make you feel better.
If the cause of your pericarditis is bacterial, you may have fever, chills, and an above-normal white cell count. If the cause is viral, you may have flu-like or stomach symptoms.
Most often, the cause of pericarditis isn’t known. This is called idiopathic pericarditis.
In general, pericarditis can have infectious or noninfectious causes. Infectious causes include:
- fungi and parasites, which are both very rare causes
Noninfectious causes include:
Your doctor will ask about your medical history, what your symptoms are, when your symptoms began, and what seems to make them worse.
They’ll give you a physical exam. When your pericardium is inflamed, the amount of fluid may increase between the two layers of tissue in the sac, resulting in an effusion. The doctor will listen with a stethoscope for signs of excess fluid.
They’ll also listen for friction rub. This is the noise of your pericardium rubbing against the outer layer of your heart.
Other tests used in diagnosis include:
- chest X-ray, which shows the shape of your heart and possible excess fluid
- electrocardiogram (ECG or EKG) to check on your heart rhythm and see if the voltage signal is reduced because of excess fluid
- echocardiogram, which uses sound waves to show the shape and size of your heart and whether there is fluid collection around the heart
- MRI, which gives a detailed view of your pericardium, including whether it is thickened, inflamed, or if there’s a fluid collection
- CT scan, which gives a detailed picture of your heart and pericardium
- right heart catheterization, which gives information about the filling pressure in your heart
- blood tests to look for markers of inflammation that suggest pericarditis or any suspected systemic disease
Treatment for pericarditis will depend on its underlying cause, if it’s known. If you have a bacterial infection, you may be given antibiotics.
In most cases, according to the American Heart Association, pericarditis is mild and will clear up on its own with simple treatment, such as anti-inflammatory medications and rest.
If you have other medical risks, your doctor may initially treat you in the hospital.
Treatment aims to reduce your pain and inflammation and minimize risk of recurrence. The usual therapy for people without other medical risks includes:
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for both pain and inflammation. Ibuprofen or aspirin provide relief quickly.
If your pain is severe, your doctor may prescribe a stronger medication.
Colchicine is an inflammation-reducing drug that’s effective in minimizing duration of symptoms and preventing pericarditis recurrences.
Corticosteroids are effective in reducing pericarditis symptoms.
Surgery may be considered in recurrent pericarditis that doesn’t respond to other treatment. Removal of the pericardium is called pericardiectomy. This treatment is usually reserved as a last-line therapy.
Drainage of excess fluid may be necessary. This can be performed surgically or by insertion of a catheter. This is called pericardiocentesis or pericardial window.
You may not be able to prevent pericarditis, but you can minimize the risk of pericarditis recurrence. It’s important to follow your treatment plan.
Until you fully recover, rest and avoid strenuous physical activity. Discuss with your doctor how long you should limit your activity.
If you see any signs of recurrence, check with your doctor as soon as possible.
Recovery from pericarditis takes time. In some cases, it may take you weeks for symptoms to complete resolve.
Most cases of pericarditis are mild and without complications. But there can be complications with chronic pericarditis, including fluid buildup and constriction of the pericardium.
Treatments for these complications are available, including surgery. Research about medical treatment options is ongoing.
If pericarditis becomes chronic, you may need to continue taking NSAIDs or other drugs.
Seek help right away if you have any type of chest pain, as it can be a sign of something more serious.