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.
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.
Pericarditis can cause chest pain that:
You also may feel the need to bend over or hold your chest to breathe more comfortably.
Other symptoms include:
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.
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.
There are many causes of pericarditis:
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.
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:
Treatment for acute pericarditis may include medication for pain and inflammation, such as ibuprofen and aspirin. Depending on the cause of your pericarditis, you may need an antibiotic or antifungal medication.
If your symptoms are severe, last longer than 2 weeks, or clear up and then return, your doctor may also prescribe an anti-inflammatory drug called colchicine. Colchicine can help control the inflammation and prevent pericarditis from returning weeks or even months later.
If you need to take large doses of ibuprofen, your doctor may prescribe medications to ease gastrointestinal symptoms. If you take large doses of nonsteroidal anti-inflammatory drugs (NSAIDs), you will 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 caused by constrictive pericarditis. If you develop a heart rhythm problem, your doctor will talk to you about treatment.
Your doctor may also talk to you about treatment with steroids or other medications, such as azathioprine, IV human immunoglobulins, anakinra.
Most times, medications are the only treatment needed for patients with pericarditis. But, if fluid builds up in the pericardium and compresses the heart, you may need a procedure called pericardiocentesis. A long, thin tube called a catheter is used to drain the extra fluid. The catheter and a needle are guided to the pericardium with the use of echocardiography. If the fluid cannot be drained with the needle, a surgical procedure called a pericardial window is performed.
If you have constrictive pericarditis, you may need to have some of your pericardium removed. The surgery is called a pericardiectomy.
Surgery is not usually used as treatment for patients with recurrent pericarditis, but your doctor may talk to you about it if other treatments aren’t successful.
After you recover from pericarditis, you should be able to return to your normal activities without any reason for concern. Your doctor will talk to you about what to expect.
The multidisciplinary team of experts in the Center for the Diagnosis and Treatment of Pericardial Diseases includes cardiologists, cardiac surgeons, nurses and other specialists, such as rheumatologists and infectious disease physicians. We provide:
If you need more information or would like to make an appointment with a specialist, contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
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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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 05/03/2019