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Acute pericarditis is inflammation of the membrane surrounding the heart that develops suddenly and causes sharp chest pain. The cause is usually a viral or bacterial infection. The condition is treatable and often curable, with symptoms lasting less than four to six weeks. But if left untreated, it can lead to serious complications.
Overview
What Is Acute Pericarditis?
Pericarditis occurs when the pericardium, the thin, two-layered sac that surrounds the heart, becomes inflamed, resulting in sharp chest pain or ache.
Acute pericarditis develops suddenly, but generally doesn’t last more than four weeks. The condition is often treatable, and in most cases, symptoms improve on their own. However, pericarditis may come back after treatment, also known as recurrent pericarditis.
Signs and Symptoms of Acute Pericarditis
Chest pain isn’t the only symptom of acute pericarditis. Other symptoms can include:
- Fatigue
- Shortness of breath
- Fast heartbeat or heart palpitations
- Muscle aches and pains
- Fever
- Dry cough
- Difficulty breathing while lying down
“People often report chest discomfort which is worse with deep breathing and when lying down, and relieved by sitting up,” says Sergiu Darabant, MD, a cardiologist at Miami Cardiac & Vascular Institute, part of Baptist Health South Florida.
Symptoms of pericarditis can also mimic those of a heart attack, which is why it’s important to seek medical assistance if you experience sudden chest pain.
Causes of Acute Pericarditis
In many cases, the cause of acute pericarditis is unknown. Several possible causes of acute pericarditis include:
- Viral and bacterial infections, including tuberculosis
- Chronic autoimmune conditions, like rheumatoid arthritis and lupus
- Thyroid disorders
- Injury to the chest, like knife or bullet wounds
- Inflammation after heart surgery
- Radiation therapy to the chest (such as for lung cancer), or rarely, due to cancer itself
- Certain medications like phenytoin, warfarin and heparin, and procainamide
How Is Acute Pericarditis Diagnosed?
Your healthcare provider will likely ask you about your medical history, whether you have had any respiratory conditions or recent heart surgery, or other medical conditions. They will also perform a physical exam, including listening to your chest with a stethoscope, and order diagnostic tests.
Pericarditis is a clinical diagnosis, but tests used to support the diagnosis include:
- Electrocardiogram (ECG) to check for changes in how the heart beats
- Blood tests to look for signs of inflammation
- Chest X-ray
- Echocardiogram (a heart ultrasound)
- Heart magnetic resonance imaging (MRI) to show pericardium thickening or inflammation
- Heart computerized tomography (CT) scan to show heart thickening
Treatment and Medication Options for Acute Pericarditis
The goal of treatment is to reduce pain and inflammation and to prevent the condition from recurring.
Medication Options
Treatment for acute pericarditis can include:
- Anti-inflammatory medicines such as:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Reduces swelling and pain
- Ketorolac: Often used for short-term pain control in severe cases
- Colchicine: Often used in combination with NSAIDs, this reduces recurrence rates and shortens the course of symptoms
If the condition doesn’t resolve with NSAIDs, your doctor may prescribe a low dose of prednisone, a corticosteroid, although some research suggests using corticosteroids may increase the risk of recurrence.
If the cause is related to autoimmune conditions like rheumatoid arthritis, immunosuppressants or immunomodulators, medicines that target the immune system, will be prescribed. If the pericarditis is caused by a bacterial infection, antibiotics are the usual course of treatment.
Complications of Acute Pericarditis
When pericarditis goes on for longer than four weeks, it’s no longer considered acute. When a person has symptoms for more than four weeks but less than three months despite treatment, it’s referred to as incessant pericarditis. Recurrent pericarditis occurs when the condition returns after treatment.
Constrictive Pericarditis
For symptoms that last more than three months, the condition becomes chronic, which can lead to constrictive pericarditis. “Constrictive pericarditis is a condition where chronic inflammation of the pericardium leads to stiffening of the pericardial sac, which restricts the heart's ability to fill properly as it is beating in the chest,” says Dr. Darabant. If not properly treated, it can lead to heart failure.
Pericardial Effusion
Another condition related to acute pericarditis is pericardial effusion. This is when fluid builds up in between the pericardium and the heart, putting pressure on the heart. Treatment depends on its severity and cause. If the amount of fluid is small, your healthcare provider may monitor the condition or manage it with medications. If too much fluid fills your pericardium, it can lead to cardiac tamponade, which can be life-threatening.
Cardiac Tamponade
When the pericardium fills up with too much fluid, this can constrict the heart, making it difficult for the heart chambers to fill with blood and pump it to the rest of the body. This can lead to shock, a condition in which your body’s organs aren’t receiving sufficient blood to function. If the fluid isn’t removed quickly, the condition can be fatal. A procedure called pericardiocentesis is usually performed using a needle and a small tube to remove the excess fluid around your heart.
The Takeaway
Acute pericarditis can develop suddenly and cause sharp chest pain, similar to a heart attack. While the cause is often unknown, it can be the result of an infection, autoimmune disorders, heart surgery, or chest injury. The most common treatments include NSAIDs to bring down the inflammation and pain. Symptoms usually last less than four to six weeks; however the condition can return, or become chronic, which could lead to complications such as constrictive pericarditis and pericardial effusion.
Resources We Trust
- Cleveland Clinic: Acute Pericarditis
- American Heart Association: What Is Pericarditis?
- MedlinePlus: Pericarditis
- National Heart, Lung, and Blood Institute: Heart Inflammation: Pericarditis
- Merck Manual: Acute Pericarditis
Meet Our Experts
Chung Yoon, MD
Medical Reviewer
Chung Yoon, MD, is a noninvasive cardiologist with a passion for diagnosis, prevention, intervention, and treatment of a wide range of heart and cardiovascular disorders. He enjoys clinical decision-making and providing patient care in both hospital and outpatient settings. He excels at analytical and decision-making skills and building connection and trust with patients and their families.
Erica Patino
Author
Erica Patino is a freelance writer and editor, content strategist, and usability specialist who has worked for a variety of online health outlets, including Healthline, Sharecare, and Twill Care. She was previously a senior editor at Everyday Health. She is also the founder and editor-in-chief of Hear 2 Tell, a website that covers advances in hearing loss treatment. Patino lives in Portland, Oregon, with her husband and twin sons.
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Resources
- What Is Pericarditis? American Heart Association. June 6, 2024.
- Hoit BD. Acute Pericarditis. Merck Manual. May 2024.
- Ismail TF. Acute pericarditis: Update on diagnosis and management. Clinical Medicine. 2020.
- Pericarditis. Mayo Clinic. April 9, 2024.
- Acute Pericarditis. Cleveland Clinic. April 29, 2022.
- How to Recognize Acute Pericarditis vs. a Heart Attack. Myocarditis Foundation.
- Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of Acute and Recurrent Pericarditis. Journal of the American College of Cardiology. January 2020.
- Dababneh E et al. Pericarditis. StatPearls. August 8, 2023.
- Geske JB et al. Pathophysiology and Diagnosis of Constrictive Pericarditis. American College of Cardiology. March 13, 2017.
- Willner DA et al. Pericardial Effusion. StatPearls. July 17, 2024.
- Pericarditis. Cedars-Sinai.
- Sharma NK et al. Acute Cardiac Tamponade. StatPearls. July 31, 2023.