Pericarditis is inflammation of the lining around the heart that can cause pain and is often caused by a viral infection. It can be treated with anti-inflammatory medication and rest, but more severe cases may require further treatment to prevent recurrence.
The pericardium helps keep your heart in place inside the chest wall, provides lubrication for the heart, and shields it from infection and other types of harm. Its layers have a small amount of fluid between them to prevent friction when the heart beats. When these inflame, they rub against each other, which can result in chest pain.
The cause of pericarditis is often unknown, in which case it’s referred to as idiopathic pericarditis. That said, viral infections are likely responsible for many cases.
The incidence of pericarditis is
Pericarditis shouldn’t be confused with myocarditis, which affects the heart muscle itself. Read on to learn more about pericarditis, its types, causes, symptoms, treatment, and more.
Your first episode, called acute pericarditis, typically lasts less than
But you can also develop recurrent pericarditis if your symptoms return after at least 4 weeks without them. This is caused by your immune system mistakenly attacking the pericardium. Even if you don’t have symptoms between episodes, the inflammation may still be present.
For those with multiple recurrences, full recovery can take up to 5 to 7 years. Up to
- Chronic pericarditis: This is when pericarditis lasts for more than 3 months.
- Pericardial effusion: This is a buildup of fluid in the pericardium layers, which can lead to cardiac tamponade.
- Cardiac tamponade: This is a sudden buildup of fluid in the pericardium layers that can cause your blood pressure to drop and stop your heart from being able to fill. This
requires emergency treatment. - Constrictive pericarditis: This occurs when the pericardium scars or sticks to the heart so the heart muscle can’t expand. It’s usually a chronic condition, but temporary variants have been known to occur. That said, this is rare and can develop in people with chronic pericarditis or after heart surgery.
- Effusive-constrictive pericarditis: This is when both effusion and constriction are present.
About 85% to 90% of people with pericarditis have chest pain as a symptom.
Some people may think they are having a heart attack, with a sharp or stabbing pain in their chest that comes on suddenly. The pain from pericarditis is typically sharp and may worsen as you take deep breaths. Lying down may also intensify the pain, while sitting up and leaning forward could offer some relief.
Pericarditis pain may radiate to your shoulders, neck, arms, or jaw.
Other symptoms include:
- low grade fever
- weakness or fatigue
- trouble breathing, especially when lying down
- heart palpitations
- dry cough
- swelling in your feet, legs, and ankles
Your symptoms may worsen when you:
- lie flat
- take deep breaths
- cough
- swallow
If the cause of your pericarditis is bacterial, you may have additional symptoms of fever, chills, and an above-normal white cell count. If the cause is viral, you may experience upper respiratory symptoms like cough, runny nose, or congestion. It may also feel like flu-like or stomach symptoms. These symptoms aren’t necessarily specific to these types of pericarditis.
Your symptoms may vary depending on the type of pericarditis you have. When you have sharp chest pain, it’s best to seek medical help right away.
Should I go to the ER for pericarditis?
Because pericarditis can feel like a heart attack, it’s important to go to the ER right away for treatment.
Recurrent pericarditis is an autoinflammatory disease, but viruses are presumed to be the most commo
Other infectious causes include:
- bacterial infection
- fungal infection
- parasitic infection
Noninfectious causes of other types include:
- idiopathic (unknown)
- tumors impinging on the pericardium
- complications from a heart attack
- heart surgery or procedure, such as cardiac ablation
- chest trauma
- radiation treatment
- autoimmune conditions, like lupus
- metabolic disorders, like gout
- kidney failure
- some genetic diseases, like familial Mediterranean fever
- certain medications, such as phenytoin and procainamide
When doctors can’t identify a cause, they’ll diagnose you with idiopathic pericarditis.
Treatment for pericarditis will depend on its underlying cause but generally aims to reduce your pain and inflammation and minimize the chance of recurrence.
If you have a bacterial infection, a doctor may prescribe antibiotics. Other treatments
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These may be over-the-counter or prescription-strength, depending on pain severity.
- Colchicine: This is an inflammation-reducing drug that effectively minimizes the duration of symptoms. It inhibits only part of the IL-1 cycle of autoinflammation that causes recurrent pericarditis, allowing for breakthrough events.
- IL-1 inhibitors: These drugs can treat and prevent recurrent pericarditis by stopping the cycle of autoinflammation. They may be used alongside or instead of corticosteroids. ARCALYST (rilonacept) is the only
Food and Drug Administration (FDA)-approved drug for adults and children 12 years and older to reduce the chance of recurrence. - Corticosteroids: These can help reduce inflammation and pain, but their broad systemic activity raises your chance of side effects the longer you take them. But reducing your dose or stopping too soonmay also be associated with a greater chance of pericarditis recurrence, so doctors typically recommend these drugs only in cases that don’t respond to other treatments.
- Surgery: For treatment-resistant recurrent pericarditis, doctors may recommend removing the pericardium (pericardiectomy). They may also drain fluid surgically or through a catheter (pericardiocentesis or pericardial window, respectively).
For acute pericarditis, a doctor may start with anti-inflammatories like NSAIDs and colchicine. If episodes repeat, they may switch to IL-inhibitors and corticosteroids.
Does pericarditis go away on its own?
In
Your doctor will ask about your medical history, what your symptoms were when your symptoms began, and what seems to make them worse. They’ll also perform a physical exam.
Inflammation of the pericardium can increase fluid between the two layers of tissue in the sac, resulting in effusion. The doctor will listen with a stethoscope for signs of excess fluid.
They’ll also listen for a pericardial rub, the noise of your pericardium rubbing against the outer layer of your heart.
- chest X-ray, which shows the shape of your heart and possible excess fluid
- electrocardiogram (ECG or EKG) to check on your heart rhythm
- echocardiogram to assess the shape and size of your heart and whether there’s fluid collection
- CT scans and MRI scans, which give a detailed view of your pericardium
- right heart catheterization, which gives information about the filling pressure in your heart
- blood tests to look for markers of inflammation
There’s no conclusive way to prevent pericarditis, especially viral pericarditis. But if you experience pericarditis, following your treatment plan, using colchicine, and avoiding corticosteroids may reduce the chance of it recurring.
Until you fully recover, rest and avoid strenuous physical activity. Discuss with your doctor how long you should limit your activity.
If you see any signs of recurrence, check with your doctor as soon as possible.
Recovery from pericarditis takes time. It may take weeks for symptoms to completely resolve in some cases.
Most cases of pericarditis are mild and without complications. However, there can be complications with chronic pericarditis, including fluid buildup and constriction or scarring of the pericardium.
Treatments for these complications are available, including surgery. Research about medical treatment options is ongoing.
If pericarditis becomes chronic, you may need to continue taking NSAIDs or other drugs. Full recovery can take up to 5 to 7 years for those with multiple recurrences. Interleukin-1 inhibitors may prevent flares of your pericarditis from coming back again.
Seek help right away if you have any type of chest pain, as it can be a sign of something more serious.