Pericarditis
Pericarditis is swelling and irritation of the thin, saclike tissue surrounding the heart. This tissue is called the pericardium. Pericarditis often causes sharp chest pain. The chest pain occurs when the irritated layers of the pericardium rub against each other.
Pericarditis often is mild. It may go away without treatment. Treatment for more-serious symptoms can include medicines and, very rarely, surgery. When healthcare professionals find and treat pericarditis early, that may help lower the risk of long-term complications from pericarditis.
Chest pain is the most common symptom of pericarditis. It usually feels sharp or stabbing. But some people have dull, achy or pressure-like chest pain.
Most often, pericarditis pain is felt behind the breastbone or on the left side of the chest. The pain may:
- Spread to the left shoulder and neck, or to both shoulders.
- Get worse when coughing, lying down or taking a deep breath.
- Get better when sitting up or leaning forward.
Other symptoms of pericarditis can include:
- Cough.
- Fatigue or general feeling of weakness or being sick.
- Swelling of the legs or feet.
- Low-grade fever.
- Pounding or racing heartbeat, also called heart palpitations.
- Shortness of breath when lying down.
- Swelling of the belly, also called the abdomen.
The specific symptoms depend on the type of pericarditis. Pericarditis is grouped into different categories, according to the pattern of symptoms and how long symptoms last.
- Acute pericarditis begins suddenly but doesn’t last longer than four weeks. Future episodes can occur. It may be hard to tell the difference between acute pericarditis and pain due to a heart attack.
- Recurrent pericarditis occurs about 4 to 6 weeks after a bout of acute pericarditis. No symptoms happen in between.
- Incessant pericarditis lasts about 4 to 6 weeks but less than three months. The symptoms continue over this whole time.
- Chronic constrictive pericarditis usually develops slowly and lasts longer than three months.
When to see a doctor
Get medical care right away if you have new symptoms of chest pain.
Many of the symptoms of pericarditis are like those of other heart and lung conditions. It’s important to be thoroughly checked by a healthcare professional if you have any type of chest pain.
The cause of pericarditis is often hard to determine. A cause may not be found. When this happens, it’s called idiopathic pericarditis.
Pericarditis causes can include:
- Immune system response after heart damage due to a heart attack or heart surgery. Other names for this include Dressler syndrome, post-myocardial infarction syndrome and post-cardiac injury syndrome.
- Infections, such as those caused by viruses.
- Injury to the heart or chest.
- Lupus.
- Rheumatoid arthritis.
- Other long-term health conditions, including kidney failure and cancer.
- Some medicines, such as the seizure treatment phenytoin (Dilantin) and medicine called procainamide to treat an irregular heartbeat.
When pericarditis is found and treated early, the risk of complications usually becomes lower. Complications of pericarditis can include:
- Fluid buildup around the heart, also called pericardial effusion. The fluid buildup can lead to further heart complications.
- Thickening and scarring of the heart lining, also called constrictive pericarditis. Some people with long-term pericarditis develop permanent thickening and scarring of the pericardium. The changes prevent the heart from filling and emptying properly. This complication often leads to severe swelling of the legs and abdomen, and shortness of breath.
- Pressure on the heart due to fluid buildup, also called cardiac tamponade. This life-threatening condition prevents the heart from filling properly. Less blood leaves the heart, causing a large drop in blood pressure. Cardiac tamponade requires emergency treatment.
There’s no specific way to prevent pericarditis. But you can take these steps to prevent infections, which might help lower the risk of heart inflammation:
- Stay away from people who have a viral or flu-like illness until they’ve recovered. If you’re sick with symptoms of a viral infection, try not to expose others. For instance, cover your mouth when you sneeze or cough.
- Follow good hygiene. Regular hand-washing can help prevent spreading illness. Scrub your hands with soap and water for at least 20 seconds.
- Get recommended vaccines. Stay up to date on the recommended vaccines, including those that protect against COVID-19, rubella and influenza. These are examples of viral diseases that can cause inflammation of the heart muscle, called myocarditis. Myocarditis and pericarditis can happen together due to a viral infection. Rarely, the COVID-19 vaccine can cause pericarditis and myocarditis, especially in males ages 12 through 17. Talk to your healthcare professional about the benefits and risks of vaccines.
To diagnose pericarditis, a healthcare professional examines you and asks questions about your symptoms and medical history.
The care professional listens to your heart using a device called a stethoscope. Pericarditis causes a specific sound, called a pericardial rub. The noise occurs when the two layers of the sac surrounding the heart, called the pericardium, rub against each other.
Tests
Tests to diagnose pericarditis or rule out conditions that may cause similar symptoms may include:
- Blood tests. Blood tests usually are done to check for signs of a heart attack, inflammation and infection.
- Electrocardiogram (ECG). An electrocardiogram is a quick and painless test that records the electrical signals in the heart. It can show how the heart is beating. Sticky patches called electrodes with wires attach to the chest and sometimes the arms or legs. The wires connect to a monitor, which prints or displays results.
- Chest X-ray. A chest X-ray can show changes in the size and shape of the heart. It can tell if the heart is enlarged.
- Echocardiogram. Sound waves create images of the moving heart. An echocardiogram shows how well the heart is pumping blood. It also can see any fluid buildup in the tissue surrounding the heart. The test can tell if the sac surrounding the heart affects the way the heart fills with blood or pumps blood.
- Cardiac computerized tomography (CT) scan. Cardiac CT scans use X-rays to create images of the heart and chest. The test can be used to look for heart thickening that may be a sign of constrictive pericarditis.
- Cardiac magnetic resonance imaging (MRI). This test uses magnetic fields and radio waves to create detailed images of the heart. A cardiac MRI scan can show thickening, inflammation or other changes in the thin tissue surrounding the heart.
Treatment for pericarditis depends on the cause of the symptoms and how serious they are. Mild pericarditis may get better without treatment.
Medications
Medicines often are used to treat symptoms of pericarditis. Examples include:
- Pain relievers. Pericarditis pain often can be treated using pain relievers sold without a prescription. These include aspirin and ibuprofen (Advil, Motrin IB, others). Talk with your healthcare professional before you take any non-prescription medicine. Take any medicine as directed. Sometimes, prescription-strength pain relievers are used to ease pericarditis pain.
- Colchicine (Colcrys, Mitigare, others). This medicine lowers inflammation in the body. It’s used to treat sudden pericarditis or if symptoms tend to come back. You should not take colchicine if you have liver or kidney disease. Colchicine also can affect other medicines. Your healthcare professional checks your health history before prescribing colchicine.
- Corticosteroids. Corticosteroids are strong medicines that fight inflammation. A corticosteroid such as prednisone may be given if pericarditis symptoms don’t get better with other medicines. Corticosteroids also might be prescribed if symptoms keep coming back.
- Immunosuppressants. These medicines turn down the immune system to lower the inflammation it makes. They may be used when a condition such as rheumatoid arthritis causes pericarditis.
- Immunomodulators. These medicines change the immune system’s activity to help control inflammation. One type of immunomodulator that can be used to treat pericarditis is called an interleukin 1 blocker.
If pericarditis is caused by a bacterial infection, treatment may include antibiotics. Extra fluid in the space between the pericardium’s layers also may need to be drained.
Surgeries or other procedures
If pericarditis causes fluid buildup around the heart, a surgery or other procedure may be needed to drain the fluid.
Surgeries or other procedures to treat pericarditis include:
- Pericardiocentesis. In this procedure, a sterile needle or a small tube called a catheter is used to remove and drain the excess fluid from the pericardium.
- Removal of the pericardium, also called pericardiectomy. Part or all of the pericardium may need to be removed. This is done if the sac surrounding the heart stays rigid due to constrictive pericarditis.
References
- Ferri FF. Pericarditis. In: Ferri’s Clinical Advisor 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 21, 2020.
- Bennett JE, et al., eds. Myocarditis and pericarditis. In: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 21, 2020.
- Melendo-Viu M, et al. A systematic review and meta-analysis of randomized controlled trials evaluating pharmacologic therapies for acute and recurrent pericarditis. Trends in Cardiovascular Medicine. 2022; doi:10.1016/j.tcm.2022.02.001.
- What is pericarditis? American Heart Association. https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis. Accessed Nov. 8, 2023.
- Heart inflammation. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/heart-inflammation. Accessed Nov. 30, 2021.
- Ami TR. Allscripts EPSi. Mayo Clinic. Dec. 6, 2023.
- AskMayoExpert. Acute pericarditis. Mayo Clinic; 2020.
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- AskMayoExpert. Constrictive pericarditis. Mayo Clinic; 2020.
- Medical review (expert opinion). Mayo Clinic. Dec. 8, 2023.
- Medical review (expert opinion). Mayo Clinic. Nov. 29, 2021.
- Myocarditis and pericarditis after mRNA COVID-19 vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html. Accessed Nov. 29, 2021.
- Mouch SA, et al. Myocarditis following COVID-19 mRNA vaccination. Vaccine. 2021; doi:10.1016/j.vaccine.2021.05.087.
- Mevorach D, et al. Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel. The New England Journal of Medicine. 2021; doi:10.1056/NEJMoa2109730.
- Echocardiogram (echo). American Heart Association. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/echocardiogram-echo. Accessed Dec. 8, 2023.
- Hoit BD. Cardiac tamponade. https://www.update.com/contents/search. Accessed Dec. 8, 2023.
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