Pericarditis is swelling and irritation of the thin, saclike tissue surrounding your heart (pericardium). Pericarditis often causes sharp chest pain and sometimes other symptoms. 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.
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.
- The pain usually occurs behind the breastbone or in the left side of your chest.
- It may spread to your left shoulder and neck.
- It often gets worse when you cough, lie down or take a deep breath.
- Sitting up and leaning forward makes you feel better.
Other signs and symptoms of pericarditis may include:
- Abdominal or leg swelling
- Fatigue or general feeling of weakness or being sick
- Low-grade fever
- Pounding or racing heartbeat (heart palpitations)
- Shortness of breath when lying down
The specific symptoms you have depend on the type of pericarditis you have. 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. The sooner you are evaluated, the sooner you can receive proper diagnosis and treatment. For example, although the cause of acute chest pain may be pericarditis, the original cause could have been a heart attack or a blood clot of the lungs (pulmonary embolus).
The cause of pericarditis is often hard to determine. Sometimes, doctors can't find a cause (idiopathic pericarditis).
Pericarditis causes can include:
- Heart attack or heart surgery, which may trigger pericarditis or delayed pericarditis (Dressler's syndrome, also called postmyocardial infarction syndrome or postcardiac injury syndrome)
- Systemic inflammatory disorders, including lupus and rheumatoid arthritis
- Trauma, such as injury to your heart or chest as a result of a motor vehicle or other accident
- Other health disorders, including kidney failure, AIDS, tuberculosis and cancer
Early diagnosis and treatment of pericarditis usually reduces the risk of the long-term complications. Complications of pericarditis include:
- Pericardial effusion. Pericarditis is usually associated with fluid around the heart, which can lead to more serious complications.
- Chronic constrictive pericarditis. Some people with long-term (chronic) pericarditis develop permanent thickening and scarring of the pericardium, which prevents the heart from filling and emptying properly. This unusual complication often leads to severe swelling of the legs and abdomen and shortness of breath.
- Cardiac tamponade. This life-threatening condition can develop when too much fluid collects in the pericardium. Excess fluid puts pressure on the heart and doesn't allow it to fill properly. Less blood leaves the heart, causing a dramatic drop in blood pressure. Cardiac tamponade requires emergency treatment.
The doctor will examine you and ask questions about your symptoms and medical history.
During the exam, the doctor will place a stethoscope on your chest to listen to your heart sounds. Pericarditis causes a specific sound, called a pericardial rub. The noise occurs when the two layers of the sac surrounding your 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 include:
- Electrocardiogram (ECG). An electrocardiogram is a quick and painless test that records the electrical signals in your heart. Sticky patches (electrodes) with wires attached connect to a monitor. They record the electrical signals that make your 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 your heart. The images may show an enlarged heart if excess fluid has collected in the pericardium.
- Echocardiogram. Sound waves (ultrasound) create images of the moving heart. Your doctor can use this test to see how well your heart is pumping blood and if there is fluid buildup in the pericardium.
- Cardiac computerized tomography (CT) scan. Cardiac CT scans use X-rays to create images of your heart and chest. The test can be used to look for thickening that may be a sign of constrictive pericarditis. Your doctor may order this test to rule out other causes of sudden chest pain, such as a blood clot in a lung (pulmonary embolus) or a tear in your aorta (aortic dissection).
- Cardiac magnetic resonance imaging (MRI). Cardiac MRI uses a magnetic field and radio waves to create cross-sectional images of your heart that can reveal thickening, inflammation or other changes in the pericardium.
Treatment for pericarditis depends on the cause and the severity of your symptoms. Mild pericarditis may get better without treatment.
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 your 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 doctor will carefully check your health history before prescribing colchicine.
- Corticosteroids. Corticosteroids are strong medications that fight inflammation. Your doctor may prescribe a corticosteroid such as prednisone if your symptoms don't get better with other medications, or if symptoms keep returning.
If your pericarditis is caused by a bacterial infection, you'll be treated with antibiotics and drainage, if necessary.
Surgeries or other procedures
If pericarditis causes fluid buildup around the heart, you may need drainage or surgery. Treatments include:
- Pericardiocentesis. In this procedure, a doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You'll receive a numbing medication (local anesthetic) before the procedure. The doctor uses ultrasound and echocardiogram images to guide the needle and tube to the correct location in the body. This drain stays in place for several days while you are in the hospital.
- Pericardiectomy. This surgery removes the entire pericardium. It may be done if the sac surrounding your heart has become permanently rigid due to constrictive pericarditis.
Lifestyle and home remedies
For mild pericarditis, rest and over-the-counter pain medications — taken under your doctor's direction — may be all that's needed.
While you recover, avoid strenuous physical activity and competitive sports. Such activity can trigger pericarditis symptoms. Ask your doctor how long you need to rest.
Preparing for an appointment
You're likely to start by seeing your family doctor or an emergency room physician. If you call to schedule an appointment, 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
- Write down any symptoms you're experiencing 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 problems you've had and the names of any prescription and over-the-counter medications you're taking.
- Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
- Write down the questions you want to be sure to ask your doctor.
For pericarditis, some basic questions to ask your doctor 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 doctor, don't hesitate to ask additional questions that occur to you during your appointment.
What to expect from your doctor
Your doctor 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 doctor 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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