Pericarditis

What Is Pericarditis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Joseph Bennington-Castro
By Medically Reviewed by 
Reviewed:
Medically Reviewed

Pericarditis is an inflammation of the pericardium, the sac that surrounds and holds the heart in place.

Infections, heart attacks, trauma, cancer, and autoimmune disorders can all cause pericarditis, which may be acute (short-term) or chronic (long-term).

When the tissues of the pericardium become inflamed, it can affect how your heart functions. Pericarditis is usually mild and goes away on its own, but it can be serious and lead to life-threatening complications without proper treatment.

Signs and Symptoms of Pericarditis

Chest pain is the most common symptom of pericarditis. This pain may:

  • Primarily be felt in the middle or left side of the chest, but may also affect the neck, shoulders, back, or abdomen
  • Worsen while lying down and breathing deep, and ease up when sitting up and leaning forward
  • Resemble chest pain from a heart attack
  • Come on quickly and feel sharp and stabbing, though it may also feel like an achy pressure in the area

Additional symptoms of acute pericarditis include fever, weakness, trouble breathing, coughing, and heart palpitations.

Causes and Risk Factors of Pericarditis

In many cases, it’s not known what causes a person to develop acute or chronic pericarditis.

Viral infections, such as respiratory infections like influenza or gastrointestinal viruses, are common causes of acute pericarditis. Infections from bacteria (such as tuberculosis), fungi, and parasites can also cause pericarditis, but are much less common in the United States given the low prevalence of TB and fungal and parasitic infections.

Chronic pericarditis is most often caused by autoimmune disorders, such as lupus, scleroderma, and rheumatoid arthritis.

Pericarditis may also be present with:

Other causes include:

  • Traumatic and radiation therapy-based injuries
  • Drugs such as anti-seizure, blood-thinning, and anti-arrhythmia medications

Pericarditis After a Heart Attack

Pericarditis may develop after a heart attack.

In some cases, the inflammation occurs one to three days after the heart attack, as the body tries to clean up the diseased heart tissue (causing swelling and inflammation in the process).

Pericarditis may also develop several weeks or months after a heart attack or after cardiac surgery, such as a coronary artery bypass. This late pericarditis is called Dressler syndrome, also known as post-cardiac injury syndrome or postcardiotomy pericarditis.

It’s thought to be a kind of autoimmune issue, in which the immune system erroneously attacks healthy heart tissue.

Chest pain and fever are the most common symptoms of Dressler syndrome.

How Is Pericarditis Diagnosed?

Your doctor will ask about your medical history — what symptoms you’re experiencing and whether you have or recently had any respiratory infections, heart attacks, injuries, and other medical conditions.

Next, your doctor will perform a physical exam — using a stethoscope while you are leaning forward and breathing in and out — looking for signs of excess fluid in your chest and listening for pericardial rub, a sound that occurs because of pericarditis, when the two layers of the pericardium rub against each other.

If the pericarditis is severe, your doctor may also hear crackles in your lungs, and will detect pericardial effusion (fluid between your pericardium and heart), and signs of fluid in the space between your lungs and your ribs.

One or more imaging and diagnostic tests might then be ordered, including:

  • Electrocardiogram, or EKG, a measure of your heart’s electrical activity
  • Chest X-rays, which can reveal an enlarged heart or excess pericardial fluid
  • Chest computer tomography (CT) scans
  • Cardiac magnetic resonance imaging (MRI)
  • Echocardiography, which uses sound waves to image the heart
  • Blood tests, which can detect if you’ve had or are having a heart attack, check for infection and inflammation, and help determine the cause of your pericarditis

Prognosis of Pericarditis

When treated promptly, most people recover from acute pericarditis in two weeks to three months.

It usually leaves no lasting damage to the heart or pericardium.

Duration of Pericarditis

If pericarditis lasts longer than six months, it’s considered chronic.

The two main types of chronic pericarditis are chronic effusive pericarditis and chronic constrictive pericarditis, which is rare.
Chronic effusive pericarditis occurs when fluid gradually accumulates between the two layers of the pericardium. With chronic constrictive pericarditis (see Complications, below), scar-like tissue forms in the pericardium, putting pressure on the heart.

Treatment and Medication Options for Pericarditis

Treatment options for pericarditis vary depending on whether it’s acute or chronic, how severe the condition is, and the underlying cause. Mild pericarditis may get better on its own. Rest and over-the-counter pain relievers may be all that’s needed. More severe cases require stronger medications and, in some cases, surgery.

Medication Options

To reduce inflammation and swelling, as well as fever and pain, the first line of treatment for acute pericarditis is high doses of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.

For severe chest pain, stronger medications, such as colchicine (Colcrys) and the steroid prednisone, may be used.

The American College of Cardiology notes, however, that corticosteroids have been associated with a prolonged disease course and a higher rate of recurrence, and recommends they be used only for patients who can’t take NSAIDs.

Other drugs may help treat acute pericarditis, including:

  • Antibiotics for pericarditis caused by bacteria
  • Antifungal drugs for pericarditis caused by fungi
  • Diuretics, or water pills, to remove excess fluid
If you have chronic or recurrent pericarditis, you may need to take colchicine or NSAIDs for several years, even if you’re feeling well.

Pericarditis generally clears up on its own or with medications, but complications may eventually develop that require surgical treatment.

Prevention of Pericarditis

According to the American Heart Association, a case of acute pericarditis usually can’t be prevented. But you can reduce your risk of complications and your chances of developing chronic pericarditis by getting prompt, effective treatment.

You can work to reduce your risk for some of the underlying conditions that cause pericarditis, such as coronary artery disease and heart attack. Keep your blood pressure and cholesterol in check, maintain a healthy diet, exercise regularly, and don’t smoke. Following good hygiene practices and staying up-to-date with immunizations can curb viral or bacterial infections that lead to pericarditis.

RELATED: Is Music Good for Your Heart?

Complications of Pericarditis

Pericarditis may result in one of two serious complications: cardiac tamponade and chronic constrictive pericarditis.

Cardiac tamponade is considered a medical emergency and, if left untreated, can quickly become fatal.

It develops when too much fluid builds up between the heart muscle (myocardium) and the pericardium. This puts pressure on the heart that prevents it from both filling and pumping, and leads to shock.

Cardiac tamponade can cause numerous symptoms, including:

  • Anxiety
  • Breathing problems and chest pain
  • Dizziness and fainting
  • Swelling of the abdomen
  • Drowsiness
  • Weak pulse
  • Shock, a condition in which your vital organs (brain, kidneys, bowels, and liver) do not have sufficient blood flow to function normally

A long-term, rare disease, chronic constrictive pericarditis may also be life-threatening if left untreated.

It slowly develops when pericarditis causes scar-like (fibrous) tissue to form on the pericardium, making the sac thick, stiff, and rigid.

The scarred tissue contracts over time, preventing the heart from fully stretching and filling with blood.

Chronic constrictive pericarditis can cause weakness and fatigue, difficulty breathing, and swelling in the abdomen and extremities.

Research and Statistics: Who Has Pericarditis?

It’s unclear just how common pericarditis is in the general population. But acute pericarditis accounts for 5 percent of patients admitted to the ER for chest pain.

Pericarditis can occur in men and women of all ages, but it most frequently affects men ages 20 to 50, according to the American Heart Association (AHA).

Additionally, about 15 to 30 percent of people who are treated for pericarditis may get it again, notes the AHA.

Related Conditions and Causes of Pericarditis

As noted above, the following conditions can cause pericarditis:

  • Viral infections
  • Infections from bacteria (such as tuberculosis), fungi, parasites, and other organisms
  • Heart attack

Other causes of pericarditis include:

  • Cancer, including leukemia, lung cancer, breast cancer, and melanoma
  • Kidney failure
  • Traumatic and radiation therapy injuries
  • Various drugs, such as anti-seizure, blood-thinning, and anti-arrhythmia medications
There are two other main types of heart inflammation, in addition to pericarditis:

  • Endocarditis is inflammation of the endocardium — the inner lining of the heart chambers and valves
  • Myocarditis is inflammation of the heart muscle

Resources We Love

American Heart Association

The AHA is the nation’s largest voluntary organization dedicated to cardiovascular health. Its website covers a number of heart conditions in depth, including pericarditis. And in addition to supporting and educating patients, it offers resources for caregivers too.

Cleveland Clinic

The Cleveland Clinic is a trusted source for Everyday Health editors of up-to-date info on all sorts of medical conditions — and pericarditis is no exception. Beyond the basics of the condition and how to manage it, they’ve got an expert podcast on the topic.

Mayo Clinic

Another incredibly helpful go-to source, the Mayo Clinic provides a clear, detailed review of this condition, from symptoms and diagnosis to treatment and possible complications. Plus, they feature tips on how to prepare for an appointment with your healthcare provider.

Additional reporting by Deborah Shapiro.

Editorial Sources and Fact-Checking

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