Acute Pericarditis

What is acute pericarditis?

Acute pericarditis is painful inflammation of the pericardium, the fluid-filled pouch surrounding your heart. The pain usually gets worse when you’re lying down or when you breathe in. Depending on the cause, it’s almost always treatable, and most people with this condition will recover with few or no complications.

What is the pericardium?

The pericardium is a double-layered pouch inside your chest. It holds your heart in place, and a thin layer of fluid between your heart and the inside layer reduces friction. The pericardium can provide cushioning and support to protect your heart from outside movement. However, you don't need a pericardium to survive, and many people are either born without one or have theirs removed with surgery and continue to live healthy lives.

How does this condition affect my body?

Under normal circumstances, the pericardium has enough room inside it for your heart to expand and fill up with blood between heartbeats. Inflammation of the pericardium is usually not dangerous on its own, but it can lead to dangerous complications. These happen when fluid buildup inside the pericardium — a pericardial effusion — compresses your heart.

Swelling and fluid buildup inside the pericardium can fill that space and crowd out your heart. When this happens slowly, sometimes the pericardium can stretch to allow for the extra fluid and your heart to beat properly. But when it happens quickly, the fluid pushes on your heart. So the heart doesn't have room to expand and can’t fill up with blood as it should. This reduces how much blood your heart can pump and causes a condition known as cardiac tamponade, which is a life-threatening medical emergency. Tamponade can stop your heart, which is deadly within minutes.

Who does it affect?

Acute pericarditis can happen to people at any age but is more common in men. It's also most likely to happen to people between 20 and 50 years old.

How common is this condition?

Acute pericarditis is very common, making up about 5% of all emergency room visits related to chest pain.

What are the symptoms?

Acute pericarditis can have several symptoms. Some of them are more likely to happen depending on the underlying cause of the pericarditis itself. The possible symptoms include the following.

• Chest pain (see below for more about what to expect from this).
• Fever.
• Shortness of breath (dyspnea).
• Fast heartbeat (tachycardia) or heart palpitations (the unpleasant ability to feel your own heartbeat without trying).
• Muscle aches and pains (like with a viral infection), especially in the past few days.
• Hiccups or trouble swallowing (dysphagia).
• Dry cough.

Chest pain

The main symptom of acute pericarditis is chest pain. While this pain has many similarities to chest pain from a heart attack, there are also some important differences. The pain with acute pericarditis usually has the following features:

• Fast onset. This symptom can happen very quickly, taking one or two hours to reach full strength.
• May feel different from person to person. The pain from acute pericarditis can feel either sharp or dull.
• Spreads to nearby areas. Similar to chest pain with a heart attack, this pain often radiates, meaning it spreads to nearby parts of the body.
• Changes with your position. Acute pericarditis pain tends to get worse when you lay down and gets better when you sit up or lean forward.

Other symptoms

Other symptoms are possible with acute pericarditis, but they depend on the other conditions in question. Those conditions could have caused the case of pericarditis, or the case of pericarditis caused them.

What causes the condition?

Acute pericarditis can happen for many reasons. Potential causes include:

• Infections. These include bacterial infections, especially tuberculosis, and viral infections such as HIV. Pericarditis from a fungus or a parasite is possible, but these types of infections are rare.
• Cancer. Pericardial cancer is possible but rare. Cancer can also cause pericarditis when tumors spread from elsewhere in your body and damage the pericardium.
• Immune system conditions or inflammatory disorders. Examples of these conditions include lupus, rheumatoid arthritis or Sjögren’s syndrome.
• Hormonal disorders or problems. Hypothyroidism (where your thyroid gland doesn’t make enough hormones) and ovarian hyperstimulation syndrome are potential pericarditis causes.
• Trauma. Injuries to the chest (either blunt impacts or penetration injuries like knife or bullet wounds) can irritate and inflame the pericardium.
• Heart or circulatory problems. These include heart attacks or aortic dissection (where layers on the inside of your aorta separate or tear).
• Medical causes. Acute pericarditis can happen after heart surgery, radiation therapy for cancer or as a side effect of some medications.
• Other. Acute pericarditis can also happen with heart failure, chronic kidney disease or kidney failure, liver cirrhosis or for unknown reasons.

Is it contagious?

While acute pericarditis can happen because of contagious infections, you can’t spread acute pericarditis to or catch it from other people.

How is it diagnosed?

A doctor can diagnose acute pericarditis based on a combination of your medical history and symptoms, a physical exam, and diagnostic and laboratory tests.

Diagnosing acute pericarditis usually requires two or more of the following five signs and symptoms:

1. Chest pain.
2. Pericardial friction rub. This is the sound of your pericardium rubbing against the inside of your chest wall. This sound doesn’t happen under normal circumstances. A healthcare provider can hear this sound using a stethoscope when listening to your breathing.
3. Electrical activity changes. Your heart’s electrical activity follows specific patterns, which are detectable using an electrocardiogram (ECG or EKG). Acute pericarditis tends to cause specific changes that an EKG can detect, and some of those changes will last for days or even weeks.
4. New or growing pericardial effusion. This means a buildup of fluid inside your pericardium that was new or that has increased in size.
5. Inflammation of the pericardium. This can be seen on specialized cardiac MRI pictures and/or from blood work.

What tests will be done to diagnose this condition?

Many tests can help diagnose acute pericarditis. The tests you undergo depend specifically on your symptoms, what the healthcare provider suspects, and what other health conditions you have. The possible tests include those listed below.

Lab tests

These tests look for changes in your blood and any signs of certain infections. These usually include:

• Complete blood count with differential.
• Troponin.
• C-reactive protein (see more about this test on the “Blood Tests to Determine Risk of Coronary Artery Disease” page).
• Erythrocyte sedimentation rate.
• Immune system tests to look for possible autoimmune diseases.
• Tuberculin test (to see if you have tuberculosis).
• Blood cultures (to look for bacterial infections).
• Blood urea nitrogen level and creatinine clearance tests.

Diagnostic tests

Diagnostic tests can help determine if you have acute pericarditis, and they can also offer valuable clues as to why you have it. Possible diagnostic tests include:

• Electrocardiogram (ECG or EKG). This test uses a set of sensors (usually 10) called electrodes, which stick to the skin of your chest. The electrodes can detect your heart’s electrical activity and display it as a wave on either a paper printout or on a screen display. Healthcare providers can look at the wave and determine if there are any abnormalities.
• Pericardial biopsy. Taking a tissue sample from the pericardium can sometimes help determine the underlying cause.
• Pericardiocentesis. This procedure involves removing excess fluid from the pericardium if you have a pericardial effusion and/or cardiac tamponade. Analyzing the fluid can also help determine what caused the condition in the first place.

Imaging

Some forms of diagnostic imaging can see acute pericarditis, while others can only detect problems that happen because of it. Imaging tests that are possible include:

• Chest X-rays.
• Computerized tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Echocardiogram.

How is it treated, and is there a cure?

The potential treatments for acute pericarditis depend on what’s causing it. When there’s a specific underlying cause, treatment focuses on treating that cause or any of its symptoms that lead to acute pericarditis. Your healthcare provider is the best person to explain the potential treatments when there is a known underlying cause. This is especially important because your provider can tailor the explanation to your particular condition(s) and situation.

What medications or treatments are used?

When acute pericarditis doesn’t have a specific cause that healthcare providers can find, the focus is on treating its symptoms.

Treating the symptoms of acute pericarditis may involve one or more of the following.

• Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first-line treatment for acute pericarditis. Examples include ibuprofen and aspirin, among others. Colchicine is an anti-inflammatory medication that is often used in combination with NSAIDs. If those don't work, steroid medications are also an option, but these have a slightly higher risk of side effects. Your provider may also prescribe medications to help protect your stomach lining, which may develop irritation from taking NSAIDs regularly. If the medications discussed above don’t ease your symptoms, your provider may recommend biologics. These potent medications are effective, but they can cause side effects. You may want to ask your healthcare provider if you’re a candidate for this treatment option.
• Pericardial fluid extraction (pericardiocentesis). This procedure is helpful when acute pericarditis causes a pericardial effusion. This is especially the case when the underlying cause is either an infection or cancer.
• Surgery (pericardiectomy). In rare cases, pericarditis can damage the pericardium to the point where the best option is surgery to remove it. This procedure, pericardiectomy, involves removing part or all of the pericardium. It’s possible to live without your pericardium without any long-term harmful effects.

Your healthcare provider may also advise you to change your routine and rest while you recover from this condition.

Complications/side effects of the treatment

The possible complications from treatment depend strongly on the treatments you receive, especially medications. Your healthcare provider is the best person to tell you what you expect, including possible complications, from treatment for this condition. They can also help guide you on what you can do to avoid these complications and what to do if you have them.

How do I take care of myself and manage my symptoms?

Because it has similar symptoms to a heart attack, you shouldn’t try to self-diagnose acute pericarditis or manage it without first seeing a healthcare provider. Since a heart attack is a life-threatening medical emergency, you should treat chest pain as if it is a heart attack. If it isn’t acute pericarditis, you can have permanent heart damage if you wait too long to get treatment for a heart attack.

How soon after treatment will I feel better?

The severity of your case, the underlying cause and the treatments used will all affect how long it takes you to feel better after you develop acute pericarditis. In general, most people will feel better with one to three weeks of treatment, but it may take months before you recover fully.

How can I prevent this?

Because acute pericarditis happens unpredictably, it isn’t a preventable condition. The only thing you can do is reduce your risk of developing it by avoiding situations or circumstances that can cause it.

How can I reduce my risk?

The only way to avoid developing pericarditis is to avoid circumstances that can cause it. The ways you can do this include:

• Get bacterial infections treated. Untreated bacterial infections can deal severe damage to your body, especially your heart and nearby organs. If you suspect you have a bacterial infection, getting it diagnosed and treated quickly is extremely important.
• Avoid injuries. Using proper safety equipment, especially wearing your seatbelt while traveling in a car is a key way to avoid injuries to your chest that can lead to acute pericarditis. This also includes being cautious when working with tools or machinery that can cause serious injuries to your chest.
• Follow your healthcare provider’s guidance. Seeing your healthcare provider as recommended and taking medications/treatments as prescribed can help you avoid having another occurrence of pericarditis or developing a chronic version of the condition. This is also true if you have a health condition that increases your risk of developing acute pericarditis.

What can I expect if I have this condition, and is it curable?

Acute pericarditis is usually treatable and often curable, with most people making a recovery after treatment. Between 20% to 50% of people will have this condition more than once, but certain anti-inflammatory treatment methods may reduce the risk of this happening.

Depending on why you had acute pericarditis, you may have an increased risk of developing constrictive pericarditis, a complication where scarring on your pericardium makes it thicker and less flexible. This can restrict your heart’s ability to pump. This happens in about 20% to 30% of acute pericarditis cases because of tuberculosis or bacterial infections. With cancer- or immune disorder-related pericarditis, that drops to 2% to 5%. In acute pericarditis cases with an unknown or viral cause, it happens in less than 1% of cases.

How long does this condition last, and when can I resume my usual routine and activities?

Untreated acute pericarditis can turn into other conditions, some of which are more serious or even dangerous. Because of that, you shouldn’t let this condition go untreated.

With treatment, acute pericarditis should start to improve within weeks. However, most people will need to avoid physical activity — including exercise and sports — until symptoms improve. It’s common for symptoms to flare if you exercise too early. Your healthcare provider will be able to explain what you should expect and will schedule follow-up appointments to monitor your recovery for any signs of trouble.

When should I see my healthcare provider, and when should I seek care?

If you have a history of acute pericarditis, you should watch for any returning symptoms or if your symptoms change or get worse during your recovery. If you have these symptoms, you should call your healthcare provider or get medical attention if it’s outside of their business hours.

The main symptoms to watch for are:

• Chest pain.*
• Fever.
• Dyspnea (trouble breathing).

*This symptom may be a sign of a heart attack, and you should call 911 (or the local emergency services number in your area) immediately.

A note from Cleveland Clinic

Acute pericarditis is a condition that’s most likely to cause pain. While it’s usually not a serious condition on its own, it has symptoms similar to those of a heart attack, which is a medical emergency. It can also happen in connection with other conditions like cardiac tamponade, a medical emergency. Because of those similarities and connections, you shouldn’t delay getting these symptoms checked by a healthcare provider. If you have acute pericarditis, it’s usually treatable, but some people may have it more than once.