Overview

Pericarditis is an inflammation of the pericardium, the thin sac surrounding the heart. It can present in different forms, primarily acute and chronic. Understanding the distinctions between these types is essential for early recognition, effective treatment, and long-term heart health. Though they share common symptoms, their causes, duration, and management strategies differ significantly.

Definition

Acute pericarditis refers to inflammation that develops quickly and usually lasts less than six weeks. In contrast, chronic pericarditis persists beyond three months and may involve structural changes to the pericardium, such as thickening or scarring.

Onset and Duration

The onset of acute pericarditis is sudden, often accompanied by sharp chest pain and systemic symptoms. It typically resolves with treatment within weeks. Chronic pericarditis has a gradual onset and may come and go over time, potentially requiring long-term therapy.

Symptoms

Both types can cause:

  • Sharp, stabbing chest pain

  • Pain that improves when sitting up and worsens when lying down

  • Shortness of breath

  • Fatigue

However, chronic pericarditis often involves additional symptoms like:

  • Swelling in the abdomen or legs

  • Weight loss

  • Prolonged fatigue

  • Persistent low-grade fever

Causes

Acute pericarditis causes include:

  • Viral infections (most common)

  • Bacterial infections

  • Heart surgery or trauma

  • Autoimmune diseases (e.g., lupus)

Chronic pericarditis causes include:

  • Repeated episodes of acute pericarditis

  • Long-standing autoimmune disorders

  • Radiation therapy to the chest

  • Tuberculosis or fungal infections (in endemic areas)

Diagnosis

Diagnosis for both forms involves:

  • Electrocardiogram (ECG): Detects inflammation-related changes.

  • Echocardiogram: Checks for fluid around the heart.

  • Cardiac MRI or CT: Evaluates thickening or constriction in chronic cases.

  • Blood tests: Assess inflammation markers like ESR and CRP.

Complications

Acute pericarditis complications:

  • Pericardial effusion (fluid buildup)

  • Cardiac tamponade (compression of the heart due to fluid)

Chronic pericarditis complications:

  • Constrictive pericarditis (scarred pericardium restricts heart function)

  • Heart failure-like symptoms

Treatment

Acute pericarditis treatment typically includes:

  • NSAIDs (ibuprofen, aspirin)

  • Colchicine (to reduce recurrence)

  • Corticosteroids (for autoimmune causes)

Chronic pericarditis may require:

  • Long-term colchicine

  • Immunosuppressive therapy (if autoimmune)

  • Pericardiectomy (surgical removal of the pericardium in severe cases)

Prognosis

Most cases of acute pericarditis resolve completely with early treatment. Chronic pericarditis can be more challenging and may require ongoing monitoring and intervention. Early diagnosis and proper management are key to preventing complications.

Lifestyle Adjustments

Both types benefit from:

  • Adequate rest during flare-ups

  • Avoiding strenuous activity until cleared

  • Following a heart-healthy diet

  • Managing stress

Chronic sufferers may need more permanent lifestyle changes to avoid triggers and monitor symptoms.

Monitoring and Follow-Up

Follow-up care is essential in both cases:

  • Regular ECG and echocardiogram evaluations

  • Tracking inflammatory markers

  • Medication adjustments

  • Monitoring for signs of recurrence or constriction

 

When to Seek Help

Seek immediate care if you experience:

  • Chest pain that changes with position or breathing

  • Difficulty breathing

  • Swelling in limbs or abdomen

  • Recurring fatigue and chest discomfort

Prompt treatment prevents progression and ensures better outcomes.

Conclusion

Understanding the difference between acute and chronic pericarditis empowers patients to seek help, adhere to treatments, and make informed lifestyle decisions. While both forms require medical attention, their outlooks differ greatly. With proper care, even chronic cases can be managed effectively.