How is pericarditis diagnosed?

Sharp pain in the chest and back of the shoulders and difficulty breathing are 2 major clues that you may have pericarditis rather than a heart attack. Your doctor will talk to you about your symptoms and medical history, such as whether you have 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 doctor will listen to your heart. Pericarditis can cause a rubbing or creaking sound, caused by the rubbing of the inflamed lining of the pericardium. This is called the “pericardial rub” and is best heard when you lean forward, hold your breath and breathe out. Depending on how bad the inflammation is, your doctor may also hear crackles in your lungs, which are signs of fluid in the space around the lungs or extra fluid in the pericardium.

Cleveland Clinic imaging specialists in the Center for the Diagnosis and Treatment of Pericardial Diseases often 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:

  • Chest X-ray to see the size of your heart and any fluid in your lungs.
  • Electrocardiogram (ECG or EKG) to look for changes in your heart rhythm. In about half of all patients with pericarditis, the heart rhythm goes through a sequence of four distinct patterns. Some patients do not have any changes, and if they do, they may be temporary.
  • Echocardiogram (echo) to see how well your heart is working and check for fluid or pericardial effusion around the heart. An echo will show the classic signs of constrictive pericarditis, including a stiff or thick pericardium that constricts the heart’s normal movement.
  • Cardiac MRI to check for extra fluid in the pericardium, pericardial inflammation or thickening, or compression of the heart. A contrast agent called gadolinium is used during this highly specialized test.
  • CT scan to look for calcium in the pericardium, fluid, inflammation, tumors and disease of the areas around the heart. Iodine dye is used during the test to get more information about the inflammation. This is an important test for patients who may need surgery for constrictive pericarditis.
  • Cardiac catheterization to get information about the filling pressures in the heart. This is used to confirm a diagnosis of constrictive pericarditis.
  • Blood tests can be used to make sure you are not having a heart attack, to see how well your heart is working, test the fluid in the pericardium and help find the cause of pericarditis. If you have pericarditis, it is common for your sedimentation rate (ESR)and ultra sensitive C reactive protein levels (markers of inflammation) to be higher than normal. You may need other tests to check for autoimmune diseases like lupus and rheumatoid arthritis.

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

References

  • 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.
  • Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015 Nov 7;36(42):2921-64. doi: 10.1093/eurheartj/ehv318. Epub 2015 Aug 29.
  • Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, Hung J, Garcia MJ, Kronzon I, Oh JK, Rodriguez ER, Schaff HV, Schoenhagen P, Tan CD, White RD. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013 Sep;26(9):965-1012.e15. doi: 10.1016/j.echo.2013.06.023.
  • Xu B, Harb SC, Cremer PC. New Insights into Pericarditis: Mechanisms of Injury and Therapeutic Targets. Curr Cardiol Rep. 2017 Jul;19(7):60. doi: 10.1007/s11886-017-0866-6.

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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