Pericarditis is an inflammation of the pericardium, which is a thin protective sac that surrounds the heart. Symptoms of pericarditis include a sharp chest pain that occurs due to the irritated layers of the pericardium rubbing against each other.

Note: Myocarditis is an inflammation of the heart muscle. When both the heart muscle and the pericardium are inflamed, it is called myopericarditis.

How Serious Is Pericarditis?

Pericarditis is not usually serious. It is typically mild, and most people make a full recovery after 3 months with proper pericarditis treatment. However, sometimes the symptoms of pericardial inflammation can continue longer or lead to serious complications.

Importance of Quick Diagnosis

It’s important to have pericarditis diagnosed and treated early to lower the risk of serious complications such as:

Pericardial effusion (build-up of fluid around the heart).
Constrictive pericarditis (irreversible scar tissue formation and pericardium thickening that can affect the heart’s normal function).
Cardiac tamponade (pressure on the heart due to excess fluid buildup in the pericardial layers). This is a medical emergency.

Types of Pericarditis

Doctors group pericarditis into different types depending on the symptoms:

Acute pericarditis lasts less than 4 to 6 weeks. This type of pericarditis comes on suddenly and may last a few weeks. Notably, episodes may repeat periodically, and symptoms can resemble a heart attack.
Recurrent pericarditis occurs 4-6 weeks after an episode of acute pericarditis has resolved without symptoms in between these episodes. Recurrent pericarditis is usually not life-threatening.
Incessant pericarditis lasts between 4 to 12 weeks with pericarditis symptoms present throughout.
Chronic pericarditis lasts for 3 months or longer.

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Causes and Risk Factors of Pericarditis

Idiopathic Pericarditis

When the cause of pericarditis cannot be found, it is called idiopathic pericarditis.

Infectious Pericarditis

The cause of pericarditis can be viral, bacterial, fungal, or parasitic infectious diseases.

Viral pericarditis can be caused by coxsackieviruses A and B, adenoviruses, echovirus, influenza, parvovirus B19, HIV (human immunodeficiency virus), herpes viruses, Epstein-Barr virus (EBV), and cytomegalovirus (CMV).
Bacterial pericarditis can be due to tuberculosis, and less commonly, other bacterial infections such as Coxiella burnetii, Streptococcus pneumoniae, Neisseria meningitidis, and Staphylococcus.
Fungal pericarditis can be caused by Histoplasma, Candida, Coccidioides, and Blastomyces.
Parasitic infections can be a cause of pericarditis, including Echinococcus and Toxoplasma.

Note: Purulent pericarditis is a localized infection of the pericardium in which pus is present and/or leukocytes (white blood cells) are seen in the pericardial fluid.

Post-Heart Attack Pericarditis

Pericarditis can develop due to an immune system response after damage to the heart during a heart attack or after heart surgery. Other names for this type of pericarditis include Dressler syndrome, post-cardiac injury syndrome, and post-myocardial infarction syndrome.

Traumatic Pericarditis

Pericarditis can develop after trauma to the chest, such as chest injuries sustained during a motor vehicle crash.

Note: The normal pericardium is smooth and shiny. Trauma, heart surgery, acute myocardial infarction (heart attack), uremia, and malignancies can lead to fibrinous pericarditis, in which the texture of the pericardium becomes rough with fibrous adhesions.

Pericarditis Related to Other Health Conditions

Prescribed Medicine Side Effects

Certain medicines can cause pericarditis, including:

Recognizing the Symptoms of Pericarditis Symptoms

What Are The Hallmark Signs Of Pericarditis?

The most common symptom and hallmark sign of pericarditis is a sharp, stabbing chest pain. However, some people have a dull, aching chest pain or pressure-like sensation in their chest.
Pericarditis chest pain is typically located in the center of the chest behind the breastbone or on the left side of the chest.
The chest pain can spread to the left shoulder and neck or to both the right and left shoulder.
Sitting up or leaning forward may make pericarditis chest pain better.
Coughing and taking a deep breath can make pericarditis pain worse.

Other pericarditis symptoms may include:

Fatigue.
Feeling ill or generally unwell.
Heart palpitations (pounding or racing heartbeat).
Low-grade fever.
Shortness of breath, especially when lying down.
Cough.
Swelling in the lower legs and feet.
Swelling in the abdomen.

Differences Between Pericarditis and Heart Attack Symptoms

Chest pain from acute pericarditis feels sharp and stabbing. Chest pain from a heart attack is a squeezing or pressure-like chest pain that makes your chest feel tight or heavy.

Healthcare providers can make a correct diagnosis of acute pericarditis vs heart attack based on physical exams, blood tests, and electrocardiogram (ECG or EKG).

Symptoms That Require Immediate Medical Attention

Seek medical attention immediately for any new or worsening chest pain. It can be difficult to tell the difference between pericarditis versus heart attack based on symptoms alone. While uncomplicated pericarditis is not usually a life-threatening condition, a heart attack is a medical emergency.

Diagnosing Pericarditis

It’s important to seek immediate medical care for any chest pain so that healthcare professionals can make the proper diagnosis and start appropriate treatment. Acute pericarditis can appear very similar to many other conditions, both cardiac-related (heart disease) and non-cardiac, such as:

Angina pectoris
Coronary artery vasospasm
Myocardial infarction (heart attack)
Myocardial ischemia
Aortic stenosis
Aortic dissection
Rheumatic fever
Pulmonary embolism (PE)
Gastroesophageal reflux disease (GERD) or heartburn
Acute gastritis
Esophagitis
Esophageal spasm
Esophageal rupture
Peptic ulcer disease

Diagnostic Tests For Pericarditis

A healthcare professional can diagnose pericarditis based on your symptoms, medical history, physical exam, and test results. In people with pericarditis, there is a specific sound called a pericardial rub that is heard when a healthcare provider listens to heart sounds using a stethoscope. This sound occurs due to the pericardial layers rubbing together.

Some of the blood tests done to diagnose pericarditis or rule out other conditions may include:

Inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Elevated CRP and ESR indicate inflammation.
Cardiac markers like troponin and creatine kinase. High levels of these markers can be signs of a heart attack.

ECG and Imaging

Chest X-ray can show changes in heart shape and size.
Electrocardiogram (ECG or EKG) records electrical activity in the heart. It is a quick, painless test done using electrodes (sticky patches) placed on the chest, arms, and legs and connected to a machine with wires. Changes in ECG tracings can help differentiate between heart attack and acute pericarditis.
Echocardiogram uses sound waves to create images of the heart and see how well it is pumping blood. This test can also show fluid buildup around the heart.
Cardiac CT scan (computerized tomography scan) uses X-rays to create 3D images of the heart. It can show pericardial thickening and help identify constrictive pericarditis.
Cardiac MRI (magnetic resonance imaging) produces detailed images of the heart and surrounding structures using magnetic fields and radio waves. It can show pericardial thickening and inflammation or severe swelling surrounding the heart.

Treatment Options for Pericarditis

Can Pericarditis Go Away By Itself?

Mild pericarditis may go away on its own. However, it’s important to seek prompt treatment to prevent serious complications. As mentioned, it can be hard to tell the difference between pericarditis symptoms and heart attack symptoms.

What Is The First Line Treatment for Pericarditis?

Pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for pericarditis. Most people with pericarditis who do not have other risk factors or complications can be treated on an outpatient basis with rest and pain medications.

How Do You Fix Pericarditis?

Some of the medicines prescribed for pericarditis may include:

Over-the-counter anti-inflammatory painkillers such as aspirin and ibuprofen (Motrin, Advil) are the mainstay of treatment for pericarditis. Sometimes, prescription-strength pain medications are necessary to relieve pain.
Colchicine (Colcrys, Mitigare) is an anti-inflammatory drug that is used to treat acute and recurrent pericarditis. However, this medicine is not safe for people with kidney disease or liver disease. Get your free Colchicine coupon here.
Corticosteroids such as prednisone may be used to reduce inflammation of the pericardium if other medicines do not work or symptoms recur.
Immunosuppressants such as azathioprine and cyclophosphamide can be used to suppress the immune system and control inflammation. They are useful in patients who have pericarditis related to an autoimmune condition such as rheumatoid arthritis.
Immunomodulators such as interleukin 1 blockers (IL-1 blockers) alter immune system activity and help to reduce inflammation. They are used in people with refractory or recurrent pericarditis (pericarditis that does not respond to other treatments or keeps coming back).
Antibiotics or antifungals may be prescribed for pericarditis caused by a bacterial or fungal infection, respectively.

Surgical Procedures for Pericarditis

Surgery is sometimes required to drain fluid buildup around the heart. Other procedures may be necessary depending on the patient’s medical history. Some of the surgical procedures done to treat pericarditis include:

Pericardiocentesis, which involves using a sterile needle or catheter (thin tube) to drain excess fluid from the pericardium.
Pericardial window is surgical removal of a small part of the protective fluid-filled sac (pericardium) to drain excess fluid.
Pericardiectomy is the removal of a part of the pericardium to relieve pressure on the heart muscle in people with constrictive pericarditis.

Long-Term Management of Pericarditis

If you have idiopathic pericarditis or acute pericarditis, you will need to see a cardiologist (heart specialist). Most people with acute pericarditis recover within a few weeks. However, some people develop complications that require long-term management.

One of the potential complications of pericarditis is an accumulation of fluid in layers of the pericardium, which is called pericardial effusion. In severe cases, this can lead to cardiac tamponade, which is a life-threatening complication requiring immediate medical attention. Patients with a large pericardial effusion need to be under the care of a cardiothoracic surgeon due to the risk of cardiac tamponade, which can occur unpredictably.

People with complications such as tuberculosis, a viral infection, traumatic pericarditis, or uremic pericarditis usually require care from a multidisciplinary team of healthcare professionals to manage their health conditions. This includes specialists in cardiovascular medicine, cardiac and/or trauma surgeons, and medical specialists such as nephrologists and infectious disease specialists.

Prevention of Pericarditis

There is no way to 100% prevent pericarditis. But you can lower your risk by:

Staying away from people who have a viral infection or flu-like illness.
Following good hand hygiene.
Staying up-to-date with routine vaccinations, such as an annual flu shot and COVID-19 vaccines.

Living with Pericarditis

Dietary Considerations: What Foods Trigger Pericarditis?

Specific foods do not trigger pericarditis. However, certain foods can trigger inflammation in the body in general. Talk to your healthcare provider about eating an anti-inflammatory diet if this is a concern for you. Keep in mind that consuming a healthy, well-balanced diet with plenty of fruits and vegetables is beneficial for overall health.

Your healthcare provider may recommend protein restriction, sodium restriction, and potassium restriction if you are receiving dialysis for kidney failure (kidney failure can cause uremic pericarditis).

Exercise and Lifestyle Adjustments

Healthcare providers recommend limiting high-intensity physical activity during recovery from pericarditis. You should avoid strenuous activities or chest trauma, which can increase the risk of hypotension (low blood pressure) and arrhythmias (heart rhythm abnormalities).

If you have recurrent pericarditis and are a non-athlete, your healthcare provider may recommend exercise restriction until your electrocardiography, echocardiography, and C-reactive protein are normal. For athletes, doctors typically recommend at least 3 months of exercise restriction. Talk to your doctor to find out how much physical activity is suitable for you.

Prognosis: What Is The Life Expectancy Of Someone With Pericarditis?

The long-term prognosis for people with pericarditis is generally good. Once the underlying cause of pericarditis is identified and treated, most people make a full recovery without complications. However, in some cases, pericarditis can become chronic and recur frequently, which can affect the prognosis (outlook).

Life expectancy in people with pericarditis depends on many factors, such as the underlying cause of pericarditis, complications, and response to treatments. Regular follow up and monitoring can improve outcomes, quality of life, and life expectancy for individuals with pericarditis.

Support and Resources for Patients and Families

Pericarditis Alliance offers health information and virtual support groups for people with pericardial diseases.

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