Tuberculous pericarditis occurs when tuberculosis spreads to the area surrounding your heart. It can cause symptoms like chest pain and lead to life threatening complications. Prompt treatment is essential.

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis (M. tuberculosis). TB remains one of the 10 leading causes of death worldwide. Most cases occur in developing countries, but about 8,000 cases still occur annually in the United States.

While TB most often affects the lungs, it can spread to other tissues, including the heart. About 1% of people with TB develop tuberculous pericarditis, an infection of the pericardium — the sac surrounding your heart.

Read on to learn more about this condition, including symptoms, risk factors, and treatment options.

Tuberculous pericarditis often starts with nonspecific symptoms such as:

The main symptom is chest pain that might:

  • feel sharp or stabbing
  • spread to your abdomen, arms, or shoulders
  • feel worse when you breathe in deeply, cough, or swallow
  • feel worse when you lie on your left side
  • get better when you lean forward

Other symptoms include:

Most but not all people with tuberculous pericarditis also have respiratory symptoms that can include:

The same bacteria that cause pulmonary (lung) TB cause tuberculous pericarditis. Transmission of M. tuberculosis occurs when you breathe in the respiratory air droplets of someone with the infection.

M. tuberculosis can reach your lungs through your airways. About 15% of people with an infection develop symptoms outside the lungs due to the spread of the bacteria through blood or lymph fluid.

TB infection of other body parts is called extrapulmonary TB. Tuberculous pericarditis is a rare type of extrapulmonary TB.

Learn more about the types of TB.

Your risk of TB infection spreading to your pericardium is higher if you have a weakened immune system. HIV is perhaps the most significant risk factor for tuberculous pericarditis, especially in regions like Southern Africa, where both conditions are endemic.

Risk factors for TB in general include:

  • coming into close contact with somebody with TB
  • visiting or moving from a country with high rates of TB
  • working or residing in areas with a high risk of exposure, such as:
    • homeless shelters
    • correctional facilities
    • hospitals
  • having a condition that weakens your immune system, such as:
    • receiving an organ transplant

According to the Centers for Disease Control and Prevention (CDC), 73% of U.S. TB cases in 2022 occurred in people born in other countries. Among people born outside the United States, the highest rates were reported in people of Asian, Hispanic, or African backgrounds.

In the CDC data, TB was most common in people over the age of 65 years. However, children may be more prone to TB spreading to the pericardium.

To diagnose tuberculous pericarditis, a doctor will first consider your symptoms and your personal and family medical history. They may also perform the following:

A doctor can confirm the infection with a biopsy, in which they will take a sample of your pericardial fluid with a long, thin needle and perform laboratory tests to look for signs of the bacteria.

Treatment for tuberculous pericarditis has three goals:

  • eliminating and controlling the spread of bacteria
  • relieving pressure from fluid buildup around your heart
  • preventing remodeling of the heart that can cause constrictive pericarditis, which is a thickening and tightening of the sac around your heart

Doctors usually prescribe antibiotics for 6–12 months to eliminate M. tuberculosis. The most common drug combination includes:

A doctor may also need to remove fluid from your pericardium using a procedure called pericardiocentesis. This involves using imaging to guide a thin needle to drain the fluid.

If complications like constrictive pericarditis occur, a doctor may need to perform a pericardiectomy. This involves removing all or part of the pericardium to relieve pressure on your heart.

Potential treatments for preventing constrictive pericarditis include:

Without prompt treatment, tuberculous pericarditis can lead to serious complications such as:

  • pericardial fibrosis (scarring)
  • pressure on your heart (cardiac tamponade)
  • constrictive pericarditis

Tuberculous pericarditis can be life threatening, especially if you don’t receive prompt medical attention.

Having HIV can worsen your outlook with tuberculous pericarditis. Research from 2008 found that 40% of people with tuberculous pericarditis and HIV died within 6 months. The death rate was 17% among those without HIV.

Your outlook may also be worse if you require a pericardiectomy, which has a mortality rate of up to 12%, depending on the center where you receive the procedure.

Here are some frequently asked questions people have about tuberculous pericarditis.

Is tuberculous pericarditis contagious?

Generally, people with TB outside of their lungs don’t transmit the infection. However, you can still potentially transmit TB if you also have respiratory symptoms.

What is the mortality rate for tuberculous pericarditis?

The death rate for tuberculous pericarditis is high. Older research suggests a 6-month mortality rate of 17–40%.

How can I prevent tuberculous pericarditis if I have TB?

Early diagnosis and treatment of active TB can potentially help reduce the spread of bacteria to other parts of your body. Doctors usually prescribe medications to kill the bacteria.

Most people with TB have respiratory symptoms, but less than 2% develop tuberculous pericarditis, which is an infection of the sac around your heart.

Tuberculous pericarditis is a medical emergency that requires immediate attention to avoid life threatening complications. Treatment usually involves taking medications for more than 6 months to kill the bacteria.