Pericarditis

Pericarditis is inflammation of the thin sac around your heart, called the pericardium. It usually comes on quickly and can last weeks to months. The main symptom is sharp chest pain.

Pericarditis can affect anyone. But it’s most common in males between the ages of 16 and 65. An estimated 28 people per 100,000 get this condition each year. It’s often treatable.

Types

There are several types of pericarditis based on the duration and cause of it.

Types based on the duration or timing include:

• Acute pericarditis: It develops suddenly and lasts less than four to six weeks.
• Subacute pericarditis: Symptoms last beyond four to six weeks but go away within three months.
• Chronic pericarditis: It lasts more than three months after the initial attack.
• Recurrent pericarditis: It comes back after initial treatment. This happens in up to 30% of cases.

Types based on the cause include:

• Idiopathic pericarditis: It doesn’t have a known cause.
• Infectious pericarditis: A viral, bacterial, fungal or parasitic infection causes this.
• Malignant pericarditis: Cancer elsewhere in your body causes this.
• Traumatic pericarditis: It develops from an injury to your chest, like after a car accident.
• Uremic pericarditis: Kidney failure causes this.

Constrictive pericarditis can be a complication of several types of pericarditis. It happens when the layers of the sac stiffen, scar and stick together. This is a severe form.

Symptoms of pericarditis

Chest pain is a common symptom of pericarditis. The pain is sharp and stabbing. It often gets worse when you cough, swallow, breathe deeply or lie flat. It can ease when you sit up and lean forward. These specific signs often point to pericarditis, not a heart attack. The pain may also spread to your back, neck or left shoulder.

Other pericarditis symptoms include:

• Trouble breathing when you lie down
• Dry cough
• Racing or irregular heartbeat (palpitations)
• Fatigue
• Fever
• Swelling of your legs, feet and ankles (in severe cases)

If you have any of these symptoms, call a doctor right away. If you feel your symptoms are a medical emergency, call 911 or go to the nearest emergency room.

Pericarditis causes

Pericarditis has several possible causes. In North America and Western Europe, the most common causes of acute pericarditis are unknown (idiopathic) or viral.

Healthcare providers group causes into two types: infectious and non-infectious.

Infectious causes include:

• Viruses, like influenza, COVID-19, adenoviruses and HIV
• Bacteria, like tuberculosis
• Fungi and parasites (very rare)

Examples of non-infectious causes include:

• Surgery or injury to your chest
• Cancer elsewhere in your body
• Autoimmune conditions, like lupus and rheumatoid arthritis
• Uremia (a complication of untreated kidney failure)
• Severe hypothyroidism (myxedema)

Risk factors

Your risk of pericarditis is higher after:

• A heart attack (Dressler’s syndrome)
• Open heart surgery (postpericardiotomy syndrome)
• Radiation therapy
• Other treatments, like cardiac catheterization or radiofrequency ablation (RFA)

Complications of this condition

Too much fluid buildup in your pericardium can cause a complication called pericardial effusion. If the fluid builds up quickly, it can cause cardiac tamponade. This is a severe compression of your heart that keeps it from working as it should. It’s a medical emergency.

This is why it’s important to see a healthcare provider as soon as possible if you have symptoms of pericarditis. Getting treatment early can help prevent these complications.

How doctors diagnose this condition

A healthcare provider will ask about your symptoms and medical history (like if you’ve recently been sick). They’ll review your history of other conditions and surgery to look for risk factors.

Your provider will listen to your heart. Inflamed tissue makes a rubbing or creaking sound, called the “pericardial rub.” They may also hear crackles in your lungs if fluid has built up.

Your provider may suggest other tests to confirm a pericarditis diagnosis. These tests can also check for complications and may help find the cause. Tests may include:

• Chest X-ray to see the size of your heart and any fluid in your lungs
• Electrocardiogram (ECG or EKG) to check for changes in your heart rhythm
• Echocardiogram to see how well your heart is working and check for excess fluid around your heart
• Cardiac MRI to look for pericardial inflammation or thickening, or compression of your heart
• CT scan to look for calcium in your pericardium, tumors and disease of the areas around your heart
• Cardiac catheterization to learn about the filling pressures in your heart, which can confirm constrictive pericarditis
• Blood tests to help confirm or rule out pericarditis and possibly find the cause

How is it treated?

Treatment for pericarditis most often involves medication and limiting physical activity. If it’s severe, you may need fluid drainage and/or surgery.

Medication

Most people with acute pericarditis only need medicine, like:

• NSAIDs: Ibuprofen or high-dose aspirin can help with symptoms.
• Antibiotic or antifungal medication: These can treat an underlying infection.
• Colchicine (Colcrys® or Gloperba®): This is an anti-inflammatory medication. Your provider may prescribe it if you have symptoms for more than two weeks or if they come back.
• Prednisone: This is a steroid your provider may prescribe if you can’t take ibuprofen or colchicine.

You may need other medications depending on the underlying cause of pericarditis.

If you have chronic or recurrent pericarditis, you may need to take NSAIDs or colchicine for several years, even if you feel well.

Physical activity limitations

It’s important to rest while you’re recovering from pericarditis. Physical activity can make the inflammation worse. Your healthcare provider will let you know how much and how long you need to limit physical activity.

Gradually getting back to moving is also crucial to help prevent pericarditis from coming back again.

Fluid drainage

If fluid builds up in your pericardium and compresses your heart, you may need a procedure called pericardiocentesis. Your provider uses a long, thin tube to drain the extra fluid.

If your provider can’t drain the fluid with a needle, they’ll do a procedure called a pericardial window. They’ll make an opening in your pericardium through a small chest incision to drain the fluid.

Surgery

If you have constrictive pericarditis, you may need to have some of your pericardium removed. This surgery is called a pericardiectomy.

Surgery isn’t usually a treatment if you have pericarditis that keeps coming back. This is because inflammation makes healing after surgery difficult. But your provider may talk to you about it if other treatments don’t work.

When should I see my healthcare provider?

You’ll need to see your healthcare provider regularly after the initial diagnosis. They’ll want to check in on your symptoms and heart health. And they may need to adjust your treatment.

See a provider immediately if you have swelling in your feet, legs and ankles or shortness of breath every time you exert yourself. These may be signs of constrictive pericarditis. It can be life-threatening.

What can I expect if I have this condition?

You’ll need to take it easy while recovering from pericarditis. After you recover, you should be able to return to your normal activities. Don’t return to intense exercise until your provider says it’s OK. Your provider will talk to you about what to expect based on your unique situation.

With treatment, the outlook for acute pericarditis is very good. Most people recover fully. Mild cases may get better with rest. Without treatment, you may end up with chronic pericarditis.

If bacteria or tuberculosis is the cause, you may have up to a 30% risk of constrictive pericarditis. Cardiac tamponade, a complication, is more likely to happen when cancer or infection causes the condition.

About 15% to 30% of people with pericarditis have episodes of pericarditis that come and go for many years.