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Overview

What Is Pericarditis?

Pericarditis is inflammation of the pericardium, the thin, two-layered sac that surrounds and protects the heart. Acute pericarditis begins suddenly and usually lasts a limited time, while recurrent or chronic pericarditis can return or continue for longer. This heart problem can affect people of different ages, and the cause may be clear or unknown.

Symptoms

Pericarditis Symptoms

Pericarditis symptoms often include chest pain caused by irritation of the tissues around the heart. The pain may worsen with deep breathing, coughing or lying down and may improve when sitting up or leaning forward. Symptoms can vary, so a clinician should assess new chest symptoms rather than relying on the pattern alone.

  • Sharp or pressure-like chest pain (pericardial chest pain).
  • Pain that spreads to the shoulders, neck or back.
  • Shortness of breath, especially when lying down.
  • Fever.
  • Fatigue or unusual tiredness.
  • Cough.
  • A fast, fluttering or pounding heartbeat (palpitations).

Important

Chest pain needs medical assessment

New or severe chest pain cannot safely be assumed to be pericarditis. A heart attack, blood clot in the lung and other emergencies can feel similar, so seek urgent medical evaluation.

Causes

Pericarditis Causes

Pericarditis develops when the pericardial tissue becomes inflamed. Pericarditis causes may be identified through a medical history, examination and testing, but some cases remain idiopathic, meaning no clear cause is found after evaluation.

  • Viral infections and, less often, bacterial, fungal or other infections can inflame the pericardium.
  • Autoimmune or inflammatory diseases can cause the immune system to attack or irritate the pericardial tissue.
  • Kidney failure can lead to inflammation around the heart.
  • Cancer can involve or irritate the pericardium.
  • Chest injury can damage the tissue surrounding the heart.
  • Heart surgery or cardiac procedures can trigger inflammation.
  • Radiation treatment involving the chest can injure the pericardium.
  • A reaction to certain medicines can cause pericardial inflammation.

Risk Factors

Pericarditis Risk Factors

  • A recent viral illness may increase the likelihood of developing pericarditis.
  • An autoimmune or inflammatory disease is associated with a higher risk.
  • Kidney disease, particularly advanced kidney failure, can increase risk.
  • Cancer may affect the pericardium or raise the risk of inflammation.
  • Tuberculosis exposure is relevant in areas or situations where tuberculosis is more common.
  • Recent heart surgery or a cardiac procedure may precede pericardial inflammation.
  • Radiation to the chest can increase the risk of later pericardial disease.
  • A previous episode of pericarditis raises the possibility of recurrence.

Some risk factors, such as a previous episode, chronic kidney disease or an autoimmune condition, cannot be changed easily. Exposure-related and procedure-related risks depend on the circumstances and are not always preventable. Having a risk factor does not mean that a person will develop pericarditis.

Complications

Pericarditis Complications

  • Pericardial effusion is a buildup of fluid in the space around the heart.
  • Cardiac tamponade occurs when fluid or pressure prevents the heart from filling normally.
  • Constrictive pericarditis develops when a thickened or scarred pericardium restricts heart movement.
  • Recurrent pericarditis causes repeated episodes after an initial attack.
  • Reduced heart function can occur when inflammation, pressure or scarring interferes with the heart.

Seek urgent care

Watch for pressure on the heart

Rapidly worsening shortness of breath, fainting, confusion, severe weakness or low blood pressure may indicate dangerous pressure on the heart. Seek emergency care immediately if these symptoms occur.

Diagnosis

How Pericarditis Is Diagnosed

Diagnosing pericarditis depends on the overall clinical picture rather than one test. Clinicians review symptoms, examine the patient and use testing to look for inflammation or fluid around the heart. They also check for other causes of chest pain, including a heart attack, pulmonary embolism, myocarditis and other heart or lung conditions.

  • A medical history and physical examination help identify the pain pattern, recent illnesses and signs of inflammation or complications.
  • An electrocardiogram (ECG) records the heart’s electrical activity and may show patterns associated with acute pericarditis.
  • An echocardiogram can assess heart movement and look for pericardial effusion or pressure on the heart.
  • A chest X-ray, CT scan or MRI may be used when more information about the heart, lungs or pericardium is needed.
  • Blood tests can check for inflammation and heart muscle injury.
  • Additional testing may look for an underlying infection or autoimmune disease when appropriate.

What can pericarditis look like on an ECG?

Possible pericarditis ECG findings in acute disease include diffuse ST-segment elevation and PR-segment changes. ECG results can vary, and these findings are not enough to confirm pericarditis on their own. Clinicians interpret an ECG together with symptoms, examination findings and other tests.

Treatment & Management

Pericarditis Treatment and Management

Pericarditis treatment depends on the cause, severity, whether the condition has returned, kidney and gastrointestinal health, and whether fluid is affecting heart function. A clinician may adjust treatment based on test results and the risk of complications. Follow the prescribed medication plan and do not change doses without medical advice.

  • Rest and temporary activity restriction may be advised until symptoms and inflammation improve.
  • Nonsteroidal anti-inflammatory drugs can reduce pain and inflammation when they are safe to use.
  • Colchicine may help shorten an episode and lower the risk of recurrence.
  • Corticosteroids may be used for selected people when other treatments are unsuitable or ineffective.
  • Antibiotics or another cause-specific treatment may be needed when an infection or another trigger is identified.
  • Recurrent disease may require longer-term medicines and specialist care to prevent further episodes.

When are procedures needed?

Drainage of pericardial fluid may be needed when cardiac tamponade is present or when a large effusion requires evaluation or relief. Surgery may be considered for persistent constrictive pericarditis that continues to restrict heart function despite medical care.

Medication safety

Check before taking anti-inflammatory medicine

Do not self-treat chest pain or start anti-inflammatory medicines without medical advice. Extra caution is needed with kidney disease, stomach ulcers, blood-thinning treatment, pregnancy or other conditions that may make these medicines unsafe.

Outlook and Prognosis

Pericarditis Outlook and Prognosis

Many uncomplicated cases of pericarditis improve with appropriate treatment. Recovery varies according to the cause, severity, whether symptoms recur and whether complications are present.

  • A good response to treatment generally supports a more favorable recovery.
  • Repeated episodes increase the risk of recurrent or longer-lasting disease.
  • Autoimmune disease or kidney disease may make inflammation harder to control.
  • A pericardial effusion can affect the outlook, particularly if it becomes large or causes pressure.
  • Cardiac tamponade requires urgent treatment and can be life-threatening.
  • Constrictive pericarditis may cause ongoing heart restrictions and sometimes requires surgery.

Follow-up visits help clinicians monitor symptoms, inflammation, heart function and possible recurrence. Complete prescribed treatment and promptly report returning chest pain, breathlessness, fainting or swelling.

When Should You See a Doctor

When Should You See a Doctor for Pericarditis?

Call emergency services

Do not wait with emergency symptoms

Call emergency services for severe or persistent chest pain, trouble breathing, fainting, confusion, blue or gray lips, sudden weakness or signs of shock. These symptoms may signal a serious heart or lung emergency.

  • Contact a clinician promptly for new chest pain, even if it seems mild.
  • Seek medical advice for chest pain that changes with position or breathing.
  • Arrange prompt assessment for fever occurring with chest symptoms.
  • Contact a clinician if shortness of breath is worsening.
  • Report new or frequent palpitations.
  • Seek advice if symptoms return after treatment.

If you have already been diagnosed with pericarditis, follow your clinician’s follow-up plan. Ask for medical advice before changing or stopping treatment, even if you begin to feel better.

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