What Is Pericarditis? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Updated on September 17, 2024
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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). Some people may develop recurrent pericarditis, when the condition reappears after having no symptoms for at least four weeks.
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.
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 deeply, 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
Pericarditis may be caused by a viral infection or heart attack. In most cases, the cause is unknown.
Viral infections, such as respiratory infections like influenza or gastrointestinal viruses, are common causes of pericarditis. Infections from bacteria (such as tuberculosis, or TB), 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.
Pericarditis can also be a symptom of long COVID.
Chronic pericarditis is most often caused by autoimmune disorders, such as lupus, scleroderma, and rheumatoid arthritis.
Pericarditis may also be present with:
- Cancer, including lung cancer, breast cancer, melanoma, and leukemia
- HIV
- Kidney failure
Other causes include:
- Traumatic and radiation therapy-based injuries
- Drugs such as anti-seizure, blood-thinning, and anti-arrhythmic medications
Pericarditis After a Heart Attack
Pericarditis can occur one to three days after a heart attack. Inflammation and swelling develop as the body tries to heal the damaged heart tissue.
Pericarditis may also develop several weeks or months after a heart attack or after cardiac surgery, such as a coronary artery bypass, a surgical procedure that improves blood flow to the heart. This type of pericarditis is also called Dressler syndrome.
Experts think it may be an autoimmune issue, in which the immune system mistakenly 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 such as COVID, heart attacks, injuries, or other medical conditions.
Next, your doctor will perform a physical exam — using a stethoscope to listen for fluid buildup in your chest and for a sound called the pericardial rub, 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 computerized tomography (CT) scans
- Cardiac magnetic resonance imaging (MRI)
- Echocardiography, which uses sound waves to image the heart
- Blood tests, which can check for signs of a heart attack, infection, and inflammation, and help determine the cause of your pericarditis
Prognosis of Pericarditis
When treated promptly, most people recover from pericarditis in two weeks to three months. It usually leaves no lasting damage to the heart or pericardium.
Constrictive pericarditis is a more severe form of the condition where the pericardium, the sac that surrounds and protects the heart, becomes stiff or too thick. It’s more common in people who have previously had heart surgery or radiation therapy around their heart, and twice as common in men than in women. Depending on the cause, the condition is often treatable or even curable.
How Long Does Pericarditis Last?
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 the Complications section 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. Pericarditis may get better on its own, but in 15 to 30 percent of people, the condition returns after a few weeks or months. In half of these people, the condition comes back multiple times.
Rest and over-the-counter pain relievers may be all that’s needed for some cases. 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 pericarditis is nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen.
For severe chest pain, stronger medications, such as colchicine (Colcrys), an anti-inflammatory medicine, and the steroid prednisone, may be used.
For people who weigh up to 154 pounds, the standard dose of colchicine for acute pericarditis is 0.5 milligrams once daily for three months. People who weigh more than 154 pounds take the dose twice per day. The regimen cuts a person’s risk of recurrent pericarditis in half.
Colchicine may interact with other drugs, and if a dose higher than recommended is taken, could cause colchicine toxicity. Signs of toxicity are diarrhea, nausea, vomiting, abdominal pain, and fatigue. In some cases, colchicine may cause myopathy, a condition that causes muscle weakness, stiffness, cramps, and spasms.
Corticosteroids are only used in certain cases. They have been associated with a prolonged disease course and a higher rate of recurrence, so it’s recommended that steroids be used only for people who can’t tolerate NSAIDs.
Other drugs may help treat pericarditis, including:
- Antibiotics, if the cause is a bacterial infection
- Antifungal drugs, if the cause is a fungal infection
- Diuretics, or water pills, to remove excess fluid
- Immunosuppressants, if the cause is a condition like rheumatoid arthritis
- Immunomodulators, to control inflammation
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 Prevention
While pericarditis can’t be prevented, 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, such as washing your hands often, and staying up-to-date with immunizations can curb viral or bacterial infections that lead to pericarditis.
Pericarditis Complications
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 can lead 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
Chronic constrictive pericarditis is a rare disease, and can 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?
While it's unclear just how common pericarditis is in the general population, acute pericarditis accounts for 5 percent of people 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.
Related Conditions
There are two other types of heart inflammation, in addition to pericarditis. These conditions cause similar symptoms:
- Endocarditis: inflammation of the endocardium — the inner lining of the heart chambers and valves
- Myocarditis: inflammation of the heart muscle
The Takeaway
Pericarditis may be caused by a bacterial or viral infection, a heart attack, or heart surgery. The most common symptom is a sharp, stabbing pain located in the middle or left side of the chest. In most cases, pericarditis goes away on its own or with treatment with NSAIDs. However, more severe cases, such as chronic or recurrent pericarditis, may require treatment with more intense treatment or surgery.
Additional reporting by Kaitlin Sullivan.
Resources We Trust
- Mayo Clinic: Pericarditis
- Cleveland Clinic: Pericarditis
- American Heart Association: What Is Pericarditis?
- Johns Hopkins Medicine: 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.
Joseph Bennington-Castro
Author
Joseph Bennington-Castro is a science writer based in Hawaii. He has written well over a thousand articles for the general public on a wide range topics, including health, astronomy, archaeology, renewable energy, biomaterials, conservation, history, animal behavior, artificial intelligence, and many others.
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