Pericarditis is a condition involving inflammation of the pericardium—the protective sac that surrounds the heart. While often temporary and manageable, pericarditis can cause significant discomfort and, in rare cases, lead to serious complications. This article provides a comprehensive overview of the condition, covering its types, symptoms, causes, diagnosis, treatment, prevention, and more.

What Is Pericarditis?

The pericardium is a two-layered sac that encases the heart, offering protection and limiting excessive motion. It also helps lubricate the heart and prevent it from overexpanding. When this tissue becomes inflamed, it can result in sharp chest pain, breathing difficulty, and other symptoms. Pericarditis can be acute, recurring, or chronic and may stem from infections, autoimmune disorders, or unknown causes.

Approximately 5% of individuals presenting with acute chest pain are diagnosed with pericarditis, making it a relatively common cardiovascular issue. While some cases resolve on their own, others can become life-threatening if complications arise, particularly when fluid builds up around the heart.

Types of Pericarditis

Pericarditis is classified based on both its underlying cause and duration of symptoms.

By Cause:

  • Idiopathic: No identifiable cause (most common)
  • Infectious: Triggered by viral, bacterial, or fungal infections
  • Traumatic: Caused by injury to the chest
  • Malignant: Linked to cancer, such as lung or breast cancer
  • Uremic: Due to kidney failure or related metabolic disorders

By Duration:

  • Acute: Lasts less than four to six weeks, often with sudden onset
  • Incessant: Symptoms persist beyond six weeks without resolution
  • Recurrent: Returns after a symptom-free period of at least four to six weeks
  • Chronic: Lasts more than three months and may cause thickening or scarring of the pericardium

Recurrent pericarditis makes up around 30% of all diagnosed cases. Chronic cases are particularly challenging to manage because the pericardium may become stiff or thickened, potentially leading to a condition known as constrictive pericarditis, which restricts normal heart movement.

Recognizing the Symptoms

The hallmark symptom of pericarditis is sharp, central chest pain that worsens with deep breathing or lying down. It may improve when sitting up or leaning forward. Other common symptoms include:

  • Sudden chest pain, often described as stabbing or sharp
  • Accelerated heart rate (tachycardia)
  • Palpitations (fluttering sensation in the chest)
  • Difficulty swallowing (dysphagia)
  • Persistent hiccups
  • Light-headedness or fainting
  • Low-grade fever and general fatigue

Some people may experience shoulder or neck pain, which can mimic musculoskeletal or gastrointestinal conditions. Chest pain from pericarditis differs from a heart attack: while myocardial infarction pain is usually constant and related to exertion, pericardial pain varies with body position and respiration.

All types of pericarditis (acute, chronic, recurrent, and incessant) tend to present similar symptoms—the difference lies in how long the symptoms persist.

What Causes Pericarditis?

The majority of pericarditis cases are idiopathic, with no clear origin. However, viral infections—especially respiratory infections or gastrointestinal viruses—are believed to account for up to 85% of acute pericarditis cases.

Additional causes include:

  • Autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis, and scleroderma
  • Cancer (particularly lung, breast, and lymphomas)
  • Hypothyroidism, especially in severe untreated cases
  • Post-cardiac procedures, including pacemaker implantation or coronary artery bypass graft (CABG) surgery
  • Tuberculosis, especially in regions like sub-Saharan Africa or Southeast Asia
  • Myocardial infarction (Dressler syndrome), a delayed inflammatory response after heart attack
  • Certain medications, such as hydralazine and isoniazid, which may trigger drug-induced pericarditis

In developing countries, bacterial infections, particularly tuberculosis, remain a leading cause. In contrast, viral pericarditis is more common in industrialized nations.

Risk Factors

Anyone can develop pericarditis, but certain populations are more at risk:

  • Individuals assigned male at birth between ages 16 and 65
  • People with chronic kidney disease or undergoing dialysis
  • Individuals with cancer, particularly metastatic cancers
  • Autoimmune or inflammatory disease patients
  • Those with a history of cardiac surgery or trauma

Lifestyle factors, such as heavy alcohol consumption and smoking, may indirectly increase pericarditis risk through their contributions to general heart disease and infections. Likewise, untreated bacterial or viral illnesses can increase risk due to delayed immune response.

Medications that may increase risk include:

  • Phenytoin (Epanutin) – for seizure control
  • Warfarin, heparin (Coumadin, Lovenox, Fragmin) – blood thinners
  • Procainamide (Pronestyl) – for heart arrhythmias

Always consult your doctor about the risks and benefits before starting or stopping these medications.

Diagnosis and Medical Evaluation

Diagnosis is typically managed by a cardiologist. To confirm acute pericarditis, at least two of the following must be present:

  1. Sharp chest pain, often radiating to the back or left shoulder
  2. Pericardial rub (a friction sound heard via stethoscope)
  3. Electrocardiogram (ECG) changes, such as widespread ST-segment elevation
  4. Pericardial effusion (fluid accumulation around the heart)

Diagnostic tools may include:

  • Electrocardiogram (ECG) – detects abnormal heart rhythms and inflammation markers
  • Echocardiogram – ultrasound imaging to identify fluid or thickening around the heart
  • Chest X-ray or MRI – to view structural abnormalities
  • Blood tests – CRP, ESR, white blood cell count, and troponin to assess inflammation and heart injury

Differential diagnosis is crucial to exclude:

  • Heart attack (myocardial infarction)
  • Gastroesophageal reflux disease (GERD)
  • Myocarditis (inflammation of heart muscle)
  • Pulmonary embolism
  • Pneumonia
  • Costochondritis (inflammation of chest wall cartilage)

How Is Pericarditis Treated?

Treatment goals focus on relieving pain, reducing inflammation, and preventing complications. Mild cases often resolve with rest and over-the-counter medications.

Common treatments include:

  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Ibuprofen or aspirin are typically the first-line options to reduce inflammation and relieve pain. Dosage and duration depend on symptom severity.
  • Colchicine: Especially effective for preventing recurrence and often used in combination with NSAIDs. It interferes with inflammatory cell activity.
  • Corticosteroids: Such as prednisone, are used when NSAIDs and colchicine fail or are contraindicated. They offer strong anti-inflammatory effects but carry risks of side effects and recurrence.
  • Interleukin-1 blockers: Anakinra (Kineret) or rilonacept are newer biologic therapies for patients with autoimmune-related or refractory pericarditis.
  • Antibiotics or antifungals: If bacterial or fungal infection is confirmed, appropriate antimicrobial therapy is initiated based on culture and sensitivity.

For severe or persistent pericarditis, surgery may be required. The most common procedure is pericardiectomy—the surgical removal of part or all of the pericardium. It is often the only solution for constrictive pericarditis.

Lifestyle recommendations during recovery include bed rest, hydration, avoidance of strenuous activities, and ongoing follow-up.

Preventing Pericarditis and Its Recurrence

Since most pericarditis causes are unknown, complete prevention isn’t always possible. However, you can reduce risk and recurrence by:

  • Managing infections promptly
  • Monitoring and adjusting medications as advised
  • Following through with full recovery protocols
  • Discussing long-term anti-inflammatory therapy with your doctor if you’ve had a previous episode

Vaccinations against common viral illnesses like influenza or pneumonia may also lower infection-triggered pericarditis. In high-risk individuals, colchicine may be prescribed prophylactically.

Patients who’ve had one episode may benefit from extended colchicine use or NSAIDs to prevent recurrence. Maintaining a healthy lifestyle, managing chronic diseases like diabetes and kidney disease, and limiting alcohol use can help lower general cardiovascular inflammation.

Complications and Related Conditions

Pericarditis can occur alongside other chronic health conditions such as:

  • High blood pressure (hypertension)
  • Diabetes
  • Chronic kidney disease

Autoimmune conditions also increase pericarditis risk:

  • Systemic lupus erythematosus (SLE)
  • Rheumatoid arthritis
  • Fibromyalgia
  • Sjogren's syndrome
  • Mixed connective tissue disease

Serious complications include:

  • Cardiac tamponade: A life-threatening buildup of fluid in the pericardial space that compresses the heart and restricts its ability to pump effectively. Symptoms include hypotension, jugular vein distension, and muffled heart sounds (Beck's triad).
  • Constrictive pericarditis: Thickened and scarred pericardium limits diastolic heart filling. Symptoms mimic heart failure, including edema, ascites, and fatigue.
  • Pericardial effusion: Not always dangerous, but large or fast-developing effusions can lead to tamponade.

Monitoring through echocardiograms and clinical evaluations is crucial in patients with long-term or recurring pericarditis.

Living With Pericarditis

Most people recover from acute pericarditis with proper rest and medication. However, up to 50% of patients who initially require steroids may experience recurrent episodes.

To manage recurrent pericarditis:

  • Adhere strictly to prescribed medications
  • Attend regular follow-ups with your healthcare provider
  • Avoid strenuous activity during flare-ups
  • Seek emotional and mental health support when needed
  • Keep a symptom diary to help identify early signs of recurrence
  • Incorporate anti-inflammatory foods such as leafy greens, berries, and fatty fish

Living with chronic or recurrent pericarditis can be emotionally challenging. Consider joining a support group or speaking with a mental health counselor to address anxiety and lifestyle disruptions. With proper care and adjustments, many people return to full, active lives.