Understanding Pericarditis

Pericarditis is inflammation of the pericardium—the thin, two-layered sac surrounding the heart. This condition can range from mild to life-threatening and may last for days, weeks, or become chronic. While some people recover quickly with minimal intervention, others face complications if the condition goes unrecognized.

Recognizing the symptoms early is vital. Some signs may mimic a heart attack, while others slowly build up. By understanding what to look for, you can seek timely care and prevent serious complications.

Sharp Chest Pain

The hallmark symptom of pericarditis is chest pain. It’s typically:

  • Sharp or stabbing in nature

  • Located behind the breastbone or slightly to the left

  • May radiate to the neck, shoulders, or back

What makes pericarditis pain unique is its sensitivity to body position and breathing. It often:

  • Worsens when lying down or inhaling deeply

  • Improves when sitting up or leaning forward

Chest pain from pericarditis is often mistaken for a heart attack, which is why prompt medical evaluation is essential.

Fever and Chills

In cases of viral or bacterial pericarditis, the body may respond with a fever. Low-grade fevers are more common, but high temperatures can occur in more severe infections.

Accompanying symptoms might include:

  • Chills

  • Sweating

  • Fatigue

These signs suggest the immune system is actively responding to inflammation or infection, and should not be ignored.

Shortness of Breath

Inflammation of the pericardium can impair the heart’s ability to function normally, leading to breathlessness. Shortness of breath typically:

  • Occurs when lying flat (orthopnea)

  • Improves when sitting upright

  • Worsens with exertion or during sleep

This symptom can also indicate a buildup of fluid around the heart (pericardial effusion), which requires immediate medical attention.

Heart Palpitations

Some individuals with pericarditis experience an irregular or racing heartbeat. This can feel like:

  • Fluttering in the chest

  • Pounding heartbeats

  • Skipped beats

These palpitations may be due to inflammation or pressure on the heart, especially if fluid builds up in the pericardial sac. Persistent or new-onset palpitations should be evaluated by a doctor.

Fatigue and Weakness

Even mild pericarditis can leave you feeling drained. Fatigue may result from:

  • The body’s inflammatory response

  • Reduced cardiac efficiency

  • Poor sleep due to pain or breathlessness

In chronic or recurrent pericarditis, fatigue can be a lasting and frustrating symptom, interfering with daily activities and overall quality of life.

Cough or Hoarseness

A dry, persistent cough may occur if pericardial inflammation irritates nearby structures such as the trachea. Some people may also notice:

  • Mild hoarseness

  • Sore throat

  • Pressure in the chest when coughing

While not as common as chest pain or shortness of breath, these subtle symptoms can signal that inflammation is affecting more than just the heart.

Pain That Spreads

Although the pain is typically centered in the chest, it may radiate to other areas, mimicking other conditions. You might feel discomfort in:

  • The left shoulder or arm

  • The upper back

  • The neck or jaw

These symptoms can resemble those of angina or a heart attack, which underscores the importance of accurate diagnosis and prompt evaluation.

Pericardial Friction Rub

Doctors may hear a specific sound when listening to your heart with a stethoscope—a pericardial friction rub. It’s a:

  • Squeaky or scratchy sound

  • Heard during the heartbeat

  • Caused by the inflamed layers of the pericardium rubbing together

While patients may not feel this symptom, its detection during a physical exam is a strong indicator of pericarditis.

Swelling in the Abdomen or Legs

When pericarditis progresses to a condition called constrictive pericarditis or leads to significant fluid accumulation, symptoms can resemble heart failure. These may include:

  • Swelling in the legs, ankles, or feet

  • Bloating or abdominal distention

  • Weight gain from fluid retention

Such signs are more likely in chronic cases and indicate that the heart’s ability to pump efficiently is being compromised.

Low Blood Pressure

Cardiac tamponade—a dangerous complication of pericardial effusion—can cause a rapid drop in blood pressure. This occurs when fluid builds up so much that it compresses the heart, limiting blood flow. Symptoms include:

  • Dizziness or lightheadedness

  • Fainting spells

  • Confusion or difficulty concentrating

This is a medical emergency that requires immediate intervention, often through fluid drainage.

Anxiety and Panic

Because pericarditis symptoms often mimic a heart attack, anxiety is common. The chest pain, palpitations, and breathlessness can trigger:

  • Panic attacks

  • Hyperventilation

  • Sleep disturbances

Addressing both the physical and emotional components of pericarditis is crucial, especially in cases that recur or persist.

Recurring Chest Discomfort

Pericarditis may recur, with symptoms returning weeks or months after the initial episode. Recurrent pericarditis is characterized by:

  • Return of chest pain after a pain-free period

  • Flare-ups triggered by minor viral infections or physical exertion

  • Inflammation markers that spike again

Managing recurrences often involves longer-term use of anti-inflammatory medications or even corticosteroids and colchicine.

Night Sweats

While not specific to pericarditis, night sweats may accompany infections or autoimmune diseases that trigger inflammation. If you experience:

  • Profuse sweating at night

  • Associated fever

  • Weight loss or chills

…it could be a sign of an underlying condition such as tuberculosis or autoimmune pericarditis and requires further testing.

Loss of Appetite

General inflammation, discomfort, and anxiety often lead to decreased appetite. People with pericarditis may find:

  • Eating aggravates symptoms due to abdominal pressure

  • Fatigue reduces interest in meals

  • Accompanying infections reduce hunger

Over time, poor nutrition can hinder recovery, making it important to maintain a balanced diet even when eating feels difficult.

Nausea or Upset Stomach

Some people with pericarditis report gastrointestinal symptoms, which can be caused by:

  • Nearby irritation of the diaphragm

  • Medication side effects (especially NSAIDs)

  • Associated viral infections

These symptoms are often overlooked but can interfere with hydration and recovery if persistent.

Constrictive Pericarditis Signs

In some cases, chronic inflammation leads to scarring and thickening of the pericardium—a condition known as constrictive pericarditis. Symptoms include:

  • Severe fatigue

  • Fluid retention in legs and abdomen

  • Shortness of breath during routine activities

  • Decreased exercise tolerance

This condition is often mistaken for heart failure and may require pericardiectomy (surgical removal of the pericardium).

When to Seek Help

Seek immediate medical attention if you experience:

  • Sudden, severe chest pain

  • Difficulty breathing or fainting

  • Chest pain that lasts more than a few minutes

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

While some cases of pericarditis are mild, others require hospitalization and urgent treatment.

How Symptoms Differ from a Heart Attack

Though both conditions cause chest pain, they have key differences:

Feature Pericarditis Heart Attack
Pain type Sharp, stabbing Pressure, squeezing
Pain changes Worse lying down, better sitting up No positional change
Onset Gradual or sudden Usually sudden
Duration Hours to days Usually under 30 minutes
Associated fever Common Rare

When in doubt, always seek emergency care—it’s better to rule out a heart attack than risk missing one.

Diagnosis and Next Steps

Once pericarditis is suspected, doctors may confirm it through:

  • Electrocardiogram (ECG)

  • Chest X-ray

  • Echocardiogram

  • Cardiac MRI or CT

  • Blood tests for inflammation

Treatment typically involves NSAIDs, colchicine, and sometimes corticosteroids. In severe or recurrent cases, additional interventions like pericardial drainage may be required.

Conclusion

Pericarditis can cause a wide range of symptoms, from mild chest discomfort to life-threatening complications. The key is early recognition and appropriate management. Ignoring symptoms or mistaking them for something less serious can delay treatment and increase the risk of recurrence or permanent damage.

By understanding the signs—and seeking prompt medical care—you can reduce complications and recover more effectively.