Pericarditis is an inflammation of the pericardium or sac that contains your heart. Most people do well with prompt treatment, rest and medication. Others may need a procedure to drain fluid from their pericardium. In most cases, people make a full recovery. However, it can take weeks or months.
Pericarditis is an inflammation of the pericardium, the thin, two-layered, fluid-filled sac that covers the outer surface of your heart. Pericarditis usually develops suddenly and may last from weeks up to several months. The condition usually clears up after three months, but sometimes attacks can come and go for years. Sometimes there is extra fluid in the space between the pericardial layers, which is called pericardial effusion.
Both of these are types of inflammation in your heart, but they’re in different places. Myocarditis is in your heart muscle. Pericarditis happens in your pericardium (the lining around your heart). Most often, a virus causes myocarditis and pericarditis. Both can give you chest pain, but with pericarditis, your chest pain should feel better when you sit up and lean forward. With myocarditis, you’ll usually feel tired and weak.
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Pericarditis can affect anyone, but it’s most common in men and people assigned male at birth who are between the ages of 16 and 65. An estimated 28 people per 100,000 get pericarditis each year.
When you have pericarditis, the membrane around your heart is red and swollen, like the skin around a cut that becomes inflamed. The pericardium is a thin, two-layered, fluid-filled sac that covers the outer surface of your heart. It provides lubrication for your heart, shields it from infection and malignancy, and contains your heart in your chest wall. It also keeps your heart from overexpanding when blood volume increases, which keeps your heart functioning efficiently.
Pericarditis symptoms include chest pain that:
You also may feel the need to bend over or hold your chest to breathe more comfortably.
Other pericarditis symptoms include:
Swelling in your feet, legs and ankles or shortness of breath every time you exert yourself may be a symptom of constrictive pericarditis. This is a severe type of pericarditis where the pericardium gets hard and/or thick. When this happens, the heart muscle can’t expand, which keeps your heart from working as it should. Your heart can become compressed, which makes blood back up into your lungs, abdomen and legs, leading to swelling and causing symptoms of congestive heart failure. You can also develop an abnormal heart rhythm.
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.
In up to 90% of cases, the cause of pericarditis is unknown. This is called idiopathic pericarditis.
There are many causes of pericarditis:
Your risk of pericarditis is higher after:
In these cases, it’s 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. Talk to your surgeon if you’re concerned about this.
Sharp pain in your chest and back of the shoulders that feel better when you sit up and lean forward, and chest pain with breathing are two major clues that you may have pericarditis and not a heart attack. Your healthcare provider will talk to you about your symptoms and medical history (such as whether you’ve recently been sick) and review your history of heart conditions, surgery and other health problems that could put you at a higher risk of pericarditis.
Your provider will listen to your heart. The rubbing of your pericardium’s inflamed lining causes a rubbing or creaking sound called the “pericardial rub." They’ll be able to hear it best when you lean forward, hold your breath and breathe out. Depending on how bad the inflammation is, your provider may also hear crackles in your lungs, which are signs of fluid in the space around your lungs or extra fluid in your pericardium.
Healthcare providers use a variety of ways to check for pericarditis and any complications, such as pericardial effusion or constrictive pericarditis. You may need one or more tests, such as:
Most times, people with pericarditis only need medications for pericarditis treatment, depending on the suspected cause. However, if you have a fluid buildup in your pericardium, you might need to have the fluid drained. If you have constrictive pericarditis, you may need surgery.
Treatment for acute pericarditis may include medication for pain and inflammation, such as ibuprofen or high-dose aspirin. Depending on the cause of your pericarditis, you may need an antibiotic or antifungal medication.
If you have severe symptoms that last longer than two weeks, or they clear up and then return, your healthcare provider may also prescribe an anti-inflammatory drug called colchicine (Colcrys® or Gloperba®). Colchicine can help control the inflammation and prevent pericarditis from returning weeks or even months later. Your provider may also prescribe a steroid medicine called prednisone, especially if you have kidney disease that makes it difficult for you to take ibuprofen and colchicine.
If you need to take large doses of ibuprofen, your provider may prescribe medications to ease gastrointestinal (stomach and digestive) symptoms. If you take large doses of nonsteroidal anti-inflammatory drugs (NSAIDs), you’ll need frequent follow-up appointments to look for changes in your kidney and liver function.
If you have chronic or recurrent pericarditis, you may need to take NSAIDs or colchicine for several years, even if you feel well. A diuretic (“water pill”) usually helps get rid of the extra fluid constrictive pericarditis causes. If you develop a heart rhythm problem, your provider will talk to you about treatment.
If your pericarditis is caused by an infection, your provider will prescribe specific medicines to treat that infection. If your pericarditis is caused by cancer, the most effective treatment is to treat the cancer.
When fluid builds 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, a severe compression of the heart that impairs its ability to function. Cardiac tamponade is a medical emergency that requires prompt diagnosis and treatment.
This sudden buildup of fluid in between the layers of the pericardium keeps your heart from working like it should and can cause your blood pressure to drop. Because cardiac tamponade is life-threatening, your provider needs to drain the fluid immediately.
If fluid builds up in your pericardium (pericardial effusion) and compresses your heart, you may need a procedure called pericardiocentesis. Your provider uses a long, thin tube called a catheter to drain the extra fluid. Echocardiography or a CT scan helps guide the catheter and a needle to your pericardium.
If your provider can’t drain the fluid with a needle, they’ll perform a minimally invasive surgical procedure called a pericardial window. They’ll make an opening in the pericardium through a small chest incision to drain fluid from your pericardium.
If you have constrictive pericarditis, you may need to have some of your pericardium removed. This surgery is called a pericardiectomy. Surgeons perform this on people who develop scar tissue in their pericardium. It’s not normally for people who have active inflammation and chest pain from pericarditis.
Surgery isn’t usually used as a treatment for people with pericarditis that keeps coming back because inflammation makes healing after surgery difficult, but your provider may talk to you about it if other treatments aren’t successful.
You should respond to treatment within a week, but you could be taking medicine for two weeks. Recovery from surgery takes longer. It can take weeks or months for a full recovery from pericarditis.
Although you can’t prevent acute pericarditis, getting quick treatment and sticking with it can help you reduce your risk of getting it again. You should also follow your provider’s recommendations about when to start exercising again, as brisk exercise can worsen active pericarditis.
You’ll need to take it easy while recovering from pericarditis. After you recover from pericarditis, you should be able to return to your normal activities without any reason for concern. Don’t return to vigorous exercise until your provider clears you. Your healthcare provider will talk to you about what to expect.
Acute pericarditis lasts less than four to six weeks. Incessant pericarditis lasts longer than that but shorter than three months. Chronic pericarditis lasts more than three months. About 15% to 30% of people with pericarditis have repeat (or recurrent) episodes of pericarditis that come and go for many years.
The outlook is very good for people with acute pericarditis who receive treatment. Most people make a full recovery. If you have a mild case, it may get better with rest. Without treatment, some people can end up with chronic pericarditis.
If bacteria or tuberculosis caused your pericarditis, you may have up to a 30% risk of constrictive pericarditis. Cardiac tamponade, a complication of pericarditis, is more likely to happen when cancer or infection causes your pericarditis.
It’s important to keep taking the medicines your healthcare provider prescribed and to keep all follow-up appointments you have with your provider.
Contact your healthcare provider if you have symptoms of constrictive pericarditis, including:
Although chest pain is a common symptom of pericarditis, it’s also a symptom of a heart attack. Call 911 if you have chest pain because it could be a heart attack.
A note from Cleveland Clinic
If you get prompt treatment for pericarditis, you’ll most likely make a full recovery. Continuing with your treatment can help you prevent pericarditis from happening again. That’s why it’s important to keep taking prescribed medicines and go to all of your follow-up appointments. Get familiar with the symptoms of pericarditis so you can get quick treatment if it happens again.
Last reviewed by a Cleveland Clinic medical professional on 07/01/2022.
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