Pericarditis

What is pericarditis?

Pericarditis is a swelling and irritation of the pericardium, which is the sac that surrounds your heart.

See a picture of pericarditis.

What causes pericarditis?

Most of the time the cause is either not known or is thought to be a viral infection.

Less common causes of pericarditis are a heart attack, a bacterial infection, an injury to the chest, or radiation treatments for cancer. Kidney failure, HIV infection, tuberculosis, hypothyroidism, autoimmune diseases such as lupus, or certain drugs may also cause pericarditis.

What are the symptoms?

The main symptom is a sharp pain in the center of your chest or in the left side of your chest. For some people, this pain is dull instead of sharp. The pain may be worse when you lie down or take a deep breath.

The pain lasts for hours or days and does not get better when you rest. It is different from a type of chest pain called angina, which only lasts a short time and usually gets better with rest.

Other symptoms may include a mild fever, weakness, feeling very tired, coughing, hiccups, and muscle aches.

Pericarditis usually is not dangerous, but your chest pain could be caused by something more serious, like a heart attack. And getting diagnosed and treated early can help keep pericarditis from leading to other problems. That’s why you should call a doctor right away if you have any kind of sudden chest pain.

Can complications of pericarditis develop?

Pericarditis usually does not cause serious problems. Most people get better in 7 to 10 days. When there are problems, they may include:

• A buildup of fluid in the pericardial sac (pericardial effusion).
• Sudden pressure on the heart and sudden difficulty pumping enough blood (called cardiac tamponade). This can be caused by the weight and pressure of the fluid buildup if it happens quickly.
• Constrictive pericarditis, which can be caused by pericarditis that comes back or lasts longer than normal. The sac around the heart gets thick and stiff. This makes it harder for the heart to pump blood.

How is pericarditis diagnosed?

Your doctor will listen to your heart during a physical exam. He or she will also ask questions about your medical history, such as whether you've had a recent virus, radiation treatment for cancer, or tuberculosis.

Your doctor may want you to have several tests, including an electrocardiogram, a chest X-ray, and blood tests.

If the chest X-ray shows any fluid buildup, or if you have symptoms that last more than 10 days, your doctor will want you to have a test called an echocardiogram.

How is it treated?

If there are no other problems, pericarditis usually goes away on its own in a few weeks. Your doctor may suggest pain relievers that you can buy without a prescription to help take care of your pain or discomfort. In some cases, the doctor may prescribe stronger medicine.

Frequently Asked Questions

Symptoms of pericarditis include:

• Chest pain. A sharp or dull constant pain often develops. The pain may be located in the center of the chest and sometimes extends over the left shoulder. Deep breathing, lying down, or swallowing may make the pain worse; sitting up and leaning forward may improve it.
• Mild fever.
• A general feeling of weakness, fatigue, or lightheadedness.
• Shortness of breath.
• Coughing.
• Hiccups.
• Muscle aches.

The type of chest pain that occurs with pericarditis differs from angina, which usually becomes worse with exertion but does not change with deep breathing. You should tell your doctor anytime you have chest pain. In the early stages of pericarditis, it may be difficult to tell whether the pain is from the inflammation or from a possible heart attack.

If you develop complications of pericarditis, you are at risk for sudden heart failure. Symptoms of sudden heart failure include sudden severe shortness of breath, a sudden irregular or rapid heartbeat, and a cough that brings up foamy pink mucus. Sudden heart failure is a medical emergency that requires immediate care. If you experience any symptoms of sudden heart failure, call 911 or quickly get other emergency medical help.

Medical history and physical exam

A physical exam and a review of your medical history will help a doctor diagnose pericarditis, its complications, and any underlying conditions.

A doctor will ask questions about your symptoms and general health and may ask whether you've had any flu-like symptoms recently and whether you've ever had any serious infections, such as tuberculosis. Having had cancer, radiation treatments for cancer, or significant injuries to the chest are also important clues to help diagnose pericarditis.

Your doctor will listen to your heart for a sound called a pericardial friction rub, which often occurs with pericarditis. A pericardial friction rub sounds like Velcro being pulled apart. A friction rub is thought to be caused by tissue membranes as they rub together. Sometimes it is difficult to hear or recognize.

Electrocardiogram (EKG or ECG)

An inflamed pericardium can affect your heart's regular electrical impulses. An electrocardiogram (EKG or ECG) can identify any abnormal electrical activity.

Several electrocardiograms may be done over a period of weeks to monitor the heart during the treatment of pericarditis.

Chest X-ray

A chest X-ray can show the size of your heart. Your heart may be larger than normal if you have pericarditis. A chest X-ray can also help determine whether you have certain underlying causes, such as tuberculosis or pneumonia.

Echocardiogram

Echocardiogram (echo) is useful for diagnosing fluid around the heart (pericardial effusion). It is also used to check whether fluid is putting pressure on the heart (pericardial tamponade) and whether there is stiffening of the sac around the heart (constrictive pericarditis).

Blood tests

A variety of blood tests can help determine whether you have inflammation somewhere in the body, including the pericardium, or whether you have another condition that is causing the pericarditis.

Pericardiocentesis

Pericardiocentesis is a procedure that may be used if you have fluid buildup in the pericardium (pericardial effusion). During pericardiocentesis, a doctor numbs the skin on your chest, inserts a needle and sometimes a thin tube called a catheter into the area around the heart, and removes some fluid. This fluid can be sent to the lab for testing to help determine the cause of pericarditis. Removing fluid also relieves pressure on the heart.

Viral pericarditis usually improves on its own with time. Mild pain relievers may be all you need to relieve inflammation and control pain. Bacterial pericarditis requires antibiotics in addition to pain relievers.

Other conditions that may be the cause of the pericarditis (underlying conditions) will also be treated.

If complications develop and pressure on the heart (cardiac tamponade) is a concern, your doctor may need to drain fluid from the pericardial sac.

Medications

Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and relieve the pain of pericarditis. Occasionally, other stronger medicines are also used for pain relief. NSAIDs are typically used for about 4 weeks, but may be used longer.

Another type of medicine called colchicine may be used to treat pericarditis and prevent repeat (recurrent) episodes. Colchicine may be tried if other medicines do not improve your pericarditis. Colchicine also reduces inflammation, but it works differently than NSAIDs. Colchicine may be used along with NSAIDs. Colchicine is typically used for about 3 months, but may be used longer.

In rare cases, your doctor may prescribe stronger anti-inflammatory medicines called corticosteroids, such as prednisone. Corticosteroids are usually used only for severe inflammation that does not respond to milder medicines. In some cases, corticosteroids may make pericarditis worse.¹

If a bacterial infection is causing pericarditis, your doctor will prescribe antibiotics to treat it.

Be sure to report to your doctor any medicines that you are already taking. If you have pericarditis, taking anticoagulant medicines can cause bleeding into the pericardial space (hemorrhagic pericardial effusion).

Medical procedures

Your doctor may drain excess fluid buildup (pericardial effusion) in the area between the pericardium and the heart in a procedure called pericardiocentesis. This procedure is also done to reduce pressure (cardiac tamponade) around the heart. Pericardiocentesis involves using a needle and sometimes a thin tube called a catheter to drain the fluid. The need for pericardiocentesis is usually determined by how well the heart is functioning. If fluid builds up gradually and the heart is tolerating the increased fluid around it, treatment of the underlying cause may be tried first.

Constrictive pericarditis

Constrictive pericarditis is a rare complication of pericarditis that can keep the heart from pumping well. Some people develop shortness of breath, swollen legs and feet, and other symptoms of heart failure.

Your doctor may recommend a low-sodium diet, medicines such as diuretics to reduce your heart's workload, and limited activity. If symptoms persist and are severe, you may need surgery to remove the scarred part of the pericardial sac. This helps loosen the pericardium's tight hold around the heart and allows the heart to pump more effectively.

As with any heart disease, it is important to follow your doctor's advice for home treatment for pericarditis and to watch for any signs of complications or a return of pericarditis, especially shortness of breath.

Get plenty of rest until you are feeling better, especially if you have a fever. Avoid all strenuous activity that has not been approved by your doctor. In addition, it is vital that you take any medicines, especially antibiotics, as directed and keep all follow-up appointments with your doctor to monitor your recovery from an episode of pericarditis.

Organizations

• Chest Pain
• Heart Failure

Citations

1. Hoit BD, Faulx MD (2004). Diseases of the pericardium. In V Fuster et al., eds., Hurst's The Heart, 11th ed., pp. 1977–2000. New York: McGraw-Hill.

Other Works Consulted

• Hoit BD (2002). Management of effusive and constrictive pericardial heart disease. Circulation, 105(25): 2939–2942.

• LeWinter MM, Kabbani S (2005). Pericardial diseases. In E Braunwald et al., eds., Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., pp. 1757–1779. Philadelphia: Saunders.