What is pericarditis?

Pericarditis is inflammation of the pericardial sac (lining around the heart). Pericarditis feels like sharp, stabbing chest pain in the left or middle of the chest that usually comes on quickly.

Pain associated with pericarditis can be eased by sitting up or leaning forward but intensifies when lying down.

Types of pericarditis

Acute pericarditis
Acute pericarditis symptoms last three months or less and appear after flu-like symptoms. If treated early, acute pericarditis can be cleared within a week.

Recurring pericarditis
If you have frequent acute pericarditis episodes, you have recurring pericarditis. Approximately 30 percent of patients who have an episode of pericarditis have recurrent episodes.

Chronic pericarditis
Symptoms of chronic pericarditis last longer than three months.

Causes of pericarditis

The exact cause of pericarditis is not known but is believed to be caused by a viral infection, heart attack or because of complications from other diseases.
Other potential causes include:
  • Kidney attack or heart surgery
  • Radiation therapy
  • Use of medications for seizures, to thin blood or to treat irregular heartbeats

Risk factors for pericarditis

  • Age — people between 20 and 50 years old are more likely to develop pericarditis.
  • Gender — men are more likely to develop this condition.
  • Prior episode(s) of pericarditis — patients who have had pericarditis once are more likely to contract it again.

Symptoms of pericarditis

Symptoms of pericarditis depend on the classification of the condition (acute, recurring or chronic).

Acute pericarditis
The most common symptom of acute pericarditis is stabbing, sharp pain in the left side of the chest that is most intense when inhaling. The pain can shoot down the left shoulder or neck and it worsens when you cough or lie down. In many patients, it is difficult to determine if the pain is from a heart attack or pericarditis.

Recurring pericarditis
Severe pain that could prevent patients from working or performing day-to-day activities. Chest pain in recurring episodes are typically less severe than the initial episode. In many patients with recurring pericarditis, chest pain is the only symptom.

Chronic pericarditis 
Chest pain is the most common symptom of chronic pericarditis. Other symptoms may include:

  • Heart palpitations
  • Low-grade fever
  • Cough
  • Fatigue
  • Leg and abdominal swelling 

Diagnosis of pericarditis

Pericarditis is diagnosed in a physical exam after your doctor evaluates your symptoms and performs diagnostic testing such as:
  • Echocardiogram - can determine the amount of fluid in the pericardial space as well as if you have developed fibrous tissue around the heart.
  • Chest x-ray - can detect if you have calcium deposits in your pericardium; 50% of people who suffer from chronic pericarditis will have calcium deposits.
  • Cardiac catheterization - can measure the blood pressure inside the heart and major blood vessels to rule out other cardiac diseases/conditions.
  • Cardiac CT or MRI - used to evaluate the thickness of the pericardium.

Treatments for pericarditis

Treatment for pericarditis depends on the classification of the condition.

Acute pericarditis
Acute pericarditis can be treated with non-steroidal anti-inflammatory medications (NSAIDs) and antibiotics if you have an infection. NSAIDs, such as ibuprofen, can reduce the inflammation in the pericardium.

Recurring pericarditis
Colchicine is a medication that is used to treat recurring pericarditis. Colchicine kills select cells in the heart to reduce inflammation in the pericardium. If symptoms are not cleared with a long-term course of colchicine, corticosteroids may be effective.

In severe cases of recurring pericarditis, surgery may be indicated. A pericardiectomy is used as a last resort treatment for pericarditis. In this risky procedure, your surgeon will cut an incision in the chest and remove your pericardium.

Chronic pericarditis 
Though salt restriction and diuretics can help relieve the symptoms of chronic pericarditis, surgery is the only cure for the condition.

Because the risk of death in a pericardiectomy surgery is 5% to 15% (depending on the severity of your heart failure), doctors do not recommend surgery until the condition significantly interferes with daily activities.

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