The Pericardium

The pericardium is a thin, two-layered, fluid-filled sac that covers the outer surface of the heart. It provides lubrication for the heart, shields the heart from infection and malignancy, and contains the heart in the chest wall. It also keeps the heart from over-expanding when blood volume increases, which keeps the heart functioning efficiently.

What is pericarditis?

Pericarditis is an inflammation of the pericardium. Pericarditis is usually acute – it develops suddenly and may last up to several months. The condition usually clears up after 3 months, but sometimes attacks can come and go for years. When you have pericarditis, the membrane around your heart is red and swollen, like the skin around a cut that becomes inflamed. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion. Pericarditis can affect anyone, but it is most common in men aged 16 to 65.

What are the symptoms of pericarditis?

Pericarditis can cause chest pain that:

  • Is sharp and stabbing (caused by the heart rubbing against the pericardium)
  • May get worse when you cough, swallow, take deep breaths or lie flat
  • Feels better when you sit up and lean forward

You also may feel the need to bend over or hold your chest to breathe more comfortably.

Other symptoms include:

  • Pain in your back, neck or left shoulder Trouble breathing when you lie down
  • A dry cough
  • Anxiety or fatigue

Pericarditis can cause swelling in your feet, legs and ankles. This swelling may be a symptom of constrictive pericarditis. This is a serious type of pericarditis where the pericardium gets hard and/or thick. When this happens, the heart muscle can’t expand, and it keeps your heart from working like it should. Your heart can become compressed, which causes blood to back up into your lungs, abdomen and legs, and cause swelling. You can also develop an abnormal heart rhythm.

If you have symptoms of constrictive pericarditis, including shortness of breath, swelling of the legs and feet, water retention, heart palpitations, and severe swelling of the abdomen, call your cardiologist to schedule an evaluation.

Pericardial effusion and cardiac tamponade

When there is a fluid build-up in the space between the pericardium, it can cause a condition called pericardial effusion. If the fluid builds up quickly, it can cause cardiac tamponade. This is a sudden build-up of fluid in between the layers of the pericardium that keeps your heart from working like it should and can cause your blood pressure to drop. Cardiac tamponade is life-threatening and requires immediate drainage of the fluid.

If you have any symptoms of acute pericarditis, call your doctor right away. If you feel your symptoms are a medical emergency, call 911 right away to get treatment at the nearest hospital.

What causes pericarditis?

There are many causes of pericarditis:

  • Viral pericarditis is caused by a complication of a viral infection, most often a gastrointestinal virus.
  • Bacterial pericarditis is caused by a bacterial infection, including tuberculosis.
  • Fungal pericarditis is caused by a fungal infection.
  • Parasitic pericarditis is caused by an infection from a parasite.
  • Some autoimmune diseases, such as lupus, rheumatoid arthritis and scleroderma can cause pericarditis. Other causes of pericarditis include injury to the chest, such as after a car accident (traumatic pericarditis), other health problems such as kidney failure (uremic pericarditis), tumors, genetic diseases such as Familial Mediterranean Fever (FMF), or rarely, medications that suppress the immune system.

Your risk of pericarditis is higher after a heart attack, heart surgery (postpericardiotomy syndrome), radiation therapy or a percutaneous treatment, such as cardiac catheterization or radiofrequency ablation (RFA). In these cases, it is likely that the inflammation of the pericardium is an error in the body’s response to the procedure or condition. It can sometimes take several weeks for symptoms of pericarditis to develop after bypass surgery.

Many times, the cause of pericarditis is unknown. This is called idiopathic pericarditis.

About 15-30% of patients with pericarditis have repeat episodes of pericarditis that come and go for many years.

Last reviewed by a Cleveland Clinic medical professional on 05/03/2019.


  • Cremer PC, Kumar A, Kontzias A, Tan CD, Rodriguez ER, Imazio M, Klein AL. Complicated Pericarditis: Understanding Risk Factors and Pathophysiology to Inform Imaging and Treatment. J Am Coll Cardiol. 2016 Nov 29;68(21):2311-2328. doi: 10.1016/j.jacc.2016.07.785.
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At Cleveland Clinic, we have a special center dedicated to the treatment of Pericarditis. To help people evaluate all available options for treating pericarditis, Cleveland Clinic's specialists have prepared a free downloadable Pericarditis Guide to help patients better understand their condition and their treatment options.

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