Pericarditis is the inflammation of the pericardium, a thin, two-layered sac that surrounds your heart. The pericardium helps keep your heart in place inside the chest wall.
The layers have a small amount of fluid between them to prevent friction when the heart beats. When the layers inflame, it can result in chest pain.
Most of the time, pericarditis resolves on its own. But certain treatments are available to decrease the duration of the condition and prevent recurrences.
About 85 to 90 percent of people with pericarditis have chest pain as a symptom.
This 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.
Other symptoms include:
- weakness or fatigue
- trouble breathing, especially when lying down
- heart palpitations
- dry cough
- swelling in your feet, legs, and ankles
Your symptoms may worsen when you:
- lie flat
- take deep breaths
If the cause of your pericarditis is bacterial, you may have a fever, chills, and an above-normal white cell count. If the cause is viral, you may have flu-like or stomach symptoms.
Your symptoms may vary, depending on the type of pericarditis you have. When you have sharp chest pain, it’s best to seek medical help right away.
Other infectious causes include:
- bacterial infection
- fungal infection
- parasitic infection
Noninfectious causes include:
- cardiovascular issues, like a previous heart attack or surgery
- tumors impinging on the pericardium
- radiation treatment
- autoimmune conditions, like lupus
- some medications, which is rare
- metabolic disorders, like gout
- kidney failure
- some genetic diseases, like familial Mediterranean fever
But doctors will often be unable to identify a cause. If this occurs, they’ll label you as having idiopathic pericarditis.
It’s important to remember that anyone can get pericarditis.
Treatment for pericarditis will depend on its underlying cause. If you have a bacterial infection, a doctor may prescribe antibiotics.
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 the risk of recurrence.
Doctors may prescribe over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation. Ibuprofen or high dose aspirin can also provide relief quickly.
If your pain is severe, your doctor may prescribe a stronger medication.
Colchicine is an inflammation-reducing drug that effectively minimizes the duration of symptoms and prevents pericarditis recurrences.
Corticosteroids are effective in reducing pericarditis symptoms.
Surgery may be necessary for recurrent pericarditis that doesn’t respond to other treatment. Removal of the pericardium is called pericardiectomy. Typically, doctors only recommend this as a last-line therapy.
Drainage of excess fluid may be necessary. This can be performed surgically or by the insertion of a catheter. This is called pericardiocentesis or pericardial window.
Your doctor will ask about your medical history, what your symptoms were when your symptoms began, and what seems to make them worse. They’ll also perform a physical exam.
Inflammation of the pericardium can increase fluid between the two layers of tissue in the sac, resulting in 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
- echocardiogram to assess the shape and size of your heart and whether there’s fluid collection
- CT scans and MRI scans, which give a detailed view of your pericardium
- right heart catheterization, which gives information about the filling pressure in your heart
- blood tests to look for markers of inflammation
Types of pericarditis
After assessing symptoms and ordering tests, a doctor will be able to diagnose which form of pericarditis you have.
- Acute pericarditis. This is the most common form of the condition. It may occur on its own or as a symptom of an underlying disease.
- Recurring (or relapsing) pericarditis. Around
30 percentof people with acute pericarditis will experience recurrences or relapses of the condition.
- Chronic pericarditis. This is when a relapse occurs as soon as a person stops anti-inflammatory treatment.
- Pericardial effusion. This is a buildup of fluid in the pericardium layers. This can lead to cardiac tamponade.
- Cardiac tamponade. A sudden buildup of fluid in the pericardium layers can cause your blood pressure to drop and stop your heart from being able to fill. This
- Delayed pericarditis. Some people refer to this as Dressler syndrome. It often develops in the weeks after heart surgery or a heart attack.
- Constrictive pericarditis. This occurs when the pericardium scars 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. This when both effusion and constriction are present.
There’s no conclusive way to prevent pericarditis, especially cases of viral pericarditis. But if you experience pericarditis, following your treatment plan and using colchicine, and avoiding corticosteroids, may reduce the risk of it recurring.
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. It may take weeks for symptoms to completely resolve in some cases.
Most cases of pericarditis are mild and without complications. But there can be complications with chronic pericarditis, including fluid buildup and constriction or scarring 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.