Pericarditis is the inflammation of the pericardium—the thin, protective sac surrounding your heart. This condition can cause symptoms such as chest pain and difficulty breathing. It is a common cause of sudden chest pain and often follows an infection. Most cases are mild and improve with rest and over-the-counter medications, but some individuals may require prescription drugs or, in rare cases, surgery.

Types of Pericarditis

Pericarditis is classified based on its cause or duration:

By Cause:

  • Idiopathic: No known cause

  • Infectious: Caused by viruses, bacteria, or fungi

  • Traumatic: Resulting from chest injury

  • Malignant: Related to cancer

  • Uremic: Caused by kidney failure

By Duration:

  • Acute: Symptoms last up to four to six weeks

  • Incessant: Symptoms last longer than four to six weeks

  • Recurrent: Returns after a symptom-free period of four to six weeks

  • Chronic: Lasts longer than three months and may lead to thickened or scarred pericardial tissue

Pericarditis Symptoms

Common symptoms include:

  • Sharp chest pain, often worse when lying down or breathing in

  • Rapid heartbeat or palpitations

  • Difficulty swallowing

  • Frequent hiccups

  • Lightheadedness or feeling faint

Chest pain is the hallmark symptom and can feel similar to a heart attack. However, pericarditis pain tends to worsen with deep breaths or lying down, and improve when sitting upright or leaning forward—unlike heart attack pain, which usually persists regardless of position.

Causes of Pericarditis

Most cases are idiopathic, but often linked to:

  • Viral infections such as respiratory or gastrointestinal infections

  • Autoimmune diseases like lupus or rheumatoid arthritis

  • Cancer (e.g., lung, breast, or lymphoma)

  • Hypothyroidism

  • Inflammation after heart procedures such as bypass surgery or pacemaker implantation

  • Tuberculosis (especially in developing countries)

Risk Factors

People assigned male at birth between the ages of 16 and 65 are more commonly affected. Other risk factors include:

  • Chronic illnesses such as kidney failure, HIV, or cancer

  • History of heart surgery or chest trauma

  • Certain medications like phenytoin, warfarin, heparin, or procainamide

Diagnosis

Pericarditis is usually diagnosed by a cardiologist. A diagnosis requires two of the following:

  • Chest pain (sharp and positional)

  • Pericardial rub (a distinctive sound heard with a stethoscope)

  • EKG changes

  • Pericardial effusion (fluid buildup around the heart visible via imaging)

Doctors may also perform tests to rule out similar conditions such as:

  • GERD

  • Heart attack

  • Myocarditis

  • Pneumonia

Treatment

Most cases are treated with anti-inflammatory medications and rest. Treatments may include:

  • NSAIDs: Such as ibuprofen or aspirin to relieve pain

  • Colchicine: Often combined with NSAIDs to reduce recurrence

  • Corticosteroids: For inflammation that doesn’t respond to NSAIDs

  • IL-1 blockers: Such as anakinra, especially for patients who can’t take NSAIDs

  • Antibiotics: If a bacterial infection is the cause

Surgery, such as a pericardiectomy (removal of the pericardium), may be necessary for chronic or recurrent cases.

Prevention

Because most causes are unknown, preventing the first occurrence is difficult. However, strategies to prevent recurrence may include:

  • Long-term use of NSAIDs or colchicine

  • Monitoring medication side effects

  • Managing underlying health conditions

Always consult with your healthcare provider before stopping or changing any medications.

Related Conditions and Complications

Pericarditis may occur alongside:

  • High blood pressure

  • Chronic kidney disease

  • Diabetes

  • Autoimmune diseases like lupus and rheumatoid arthritis

  • Fibromyalgia

Rare but serious complications include:

  • Cardiac tamponade: Pressure on the heart from fluid buildup

  • Constrictive pericarditis: Stiffened pericardial tissue that limits heart function

Living With Pericarditis

Acute pericarditis usually resolves with proper care, but recurrence is possible. About half of those treated with corticosteroids after an initial episode may experience another. Management includes:

  • Consistent medication use

  • Rest and recovery

  • Possible physical therapy and heart-healthy nutrition

Following medical guidance and early treatment can help manage symptoms and prevent long-term complications.