What Is Pericarditis?

Pericarditis is a condition characterized by inflammation of the pericardium—the thin, sac-like membrane surrounding the heart. This membrane helps protect the heart and provides lubrication to reduce friction during heartbeats. When it becomes inflamed, it can cause sharp chest pain, shortness of breath, fatigue, and other concerning symptoms.

Pericarditis can range from mild and self-limiting to severe and chronic. It may occur suddenly (acute) or develop gradually (chronic). Understanding who is most at risk for pericarditis is key to early detection and timely intervention.

Why Identifying Risk Matters

Identifying high-risk groups for pericarditis is not just about knowing who may get sick. It’s about empowering early recognition, accurate diagnosis, and prompt treatment to prevent serious complications such as cardiac tamponade or constrictive pericarditis. The earlier the inflammation is treated, the lower the chance of recurrence or progression to chronic disease.

People with Viral Infections

Viruses are the most common cause of acute pericarditis. Individuals recovering from viral illnesses like the flu, COVID-19, HIV, or other respiratory viruses are at higher risk. These infections can irritate the pericardium, triggering an inflammatory response.

Younger adults, especially males between the ages of 20 and 50, appear more susceptible to viral pericarditis. It’s often linked with recent upper respiratory tract infections or gastrointestinal illness.

Post-Heart Attack Patients

Pericarditis may develop after a heart attack due to damage to the heart muscle. This can happen either within a few days of the event or weeks later as part of Dressler’s syndrome—a type of autoimmune pericarditis. In Dressler’s syndrome, the body mistakenly attacks its own pericardial tissue in response to injury.

Older adults and people with a history of myocardial infarction (heart attack) should be monitored closely for chest pain that persists or worsens post-event.

Individuals with Autoimmune Disorders

Autoimmune diseases such as lupus, rheumatoid arthritis, and scleroderma often involve systemic inflammation, which can extend to the heart lining. In such cases, the immune system attacks the body’s own tissues, including the pericardium.

People with established autoimmune conditions have a significantly increased risk of developing pericarditis. It may present as part of the broader disease activity and often requires long-term management with anti-inflammatory and immunosuppressive drugs.

Those Recovering from Cardiac Surgery

Patients who undergo open-heart surgery may develop post-pericardiotomy syndrome, a condition where inflammation of the pericardium occurs after surgical trauma. This is a relatively common complication and is believed to be immune-mediated.

Risk factors include the extent of the surgery, the presence of pericardial bleeding, and individual immune response. While not always severe, it can cause fever, chest pain, and fluid buildup around the heart (pericardial effusion).

Cancer Patients

Cancer—especially those affecting the lungs, breasts, or lymphatic system—can spread to the pericardium. In addition, treatments like chemotherapy and radiation therapy may damage the pericardial tissue.

Patients undergoing cancer treatment are at risk due to both direct tumor invasion and therapy-related complications. Pericarditis in these patients may signal metastatic disease or a side effect of medication, warranting immediate evaluation.

People with Kidney Disease

Advanced kidney disease, particularly in those on long-term dialysis, is a known risk factor for uremic pericarditis. This occurs when toxins normally cleared by the kidneys build up in the bloodstream and inflame the pericardium.

Uremic pericarditis is more common in individuals with end-stage renal disease (ESRD) and can present with symptoms like chest pain, fever, and pericardial friction rub.

Patients with Tuberculosis

In developing countries and areas with high TB prevalence, tuberculosis remains a significant cause of pericarditis. Tuberculous pericarditis is often chronic, difficult to diagnose early, and associated with complications like pericardial effusion and constrictive pericarditis.

Immunocompromised individuals, such as those with HIV/AIDS, are especially vulnerable. Early detection and a combination of anti-tubercular therapy and corticosteroids can improve outcomes.

Post-COVID-19 Patients

Emerging research indicates that some people recovering from COVID-19 develop pericarditis, even weeks after the initial infection. This may occur due to viral persistence, immune dysregulation, or cardiovascular stress from the infection.

Young adults and those with long COVID symptoms are increasingly being identified with post-viral pericardial inflammation, making them a newly recognized high-risk group.

Immunocompromised Individuals

People with weakened immune systems—whether due to organ transplantation, HIV infection, chemotherapy, or chronic steroid use—are more likely to develop pericarditis. The body’s reduced ability to fight off infections or inflammation contributes to vulnerability.

In these individuals, symptoms may be subtle, and diagnosis can be delayed. It’s crucial for healthcare providers to monitor for pericarditis when unexplained chest symptoms arise.

Athletes and Overtraining Syndrome

While uncommon, high-endurance athletes, particularly those who push their bodies to extremes without adequate recovery, may be at risk for pericardial inflammation. This may result from repetitive microtrauma, viral infections, or an overactive immune response triggered by excessive physical stress.

Athletes presenting with unexplained fatigue, chest discomfort, or palpitations should be evaluated for underlying cardiovascular inflammation, including pericarditis.

Children and Adolescents

Although rare, pericarditis can affect children and teens. It’s often linked to viral infections, autoimmune disorders, or post-cardiac surgery in pediatric heart disease patients. Early symptoms may mimic other childhood illnesses, making it harder to diagnose.

Pediatricians should maintain a high index of suspicion for pericarditis in kids with chest pain, fever, and rapid breathing—especially after recent infections.

People with Recurrent Pericarditis

Some individuals are prone to recurrent or chronic pericarditis, often due to autoimmune tendencies or incomplete treatment of the initial episode. These patients may have flares triggered by stress, infection, or even physical exertion.

Risk management for this group includes long-term follow-up, medication adherence, and lifestyle modification to minimize triggers.

Genetic and Family History

A genetic predisposition to autoimmune disease or cardiovascular inflammation can place some individuals at higher risk for pericarditis. While rare, familial cases of pericarditis have been reported, often with autoimmune overlap.

Understanding a patient’s family history can provide clues to recurring or unexplained cases of pericarditis.

Environmental and Occupational Exposures

Exposure to toxins, asbestos, or industrial chemicals may contribute to pericardial inflammation in some cases. Additionally, people in high-stress environments may be at higher risk due to the combined effects of mental stress and physical strain on the cardiovascular system.

Occupational health assessments may help identify pericarditis risk in vulnerable workers.

Medication-Induced Cases

Certain medications, such as hydralazine, isoniazid, phenytoin, and some cancer immunotherapies, have been associated with drug-induced pericarditis. This is usually an inflammatory reaction that resolves upon discontinuation of the drug.

Patients taking high-risk medications should be monitored for signs of pericardial inflammation, especially when symptoms develop suddenly after initiating treatment.

Conclusion: Early Recognition Saves Lives

While pericarditis may appear suddenly and cause alarming symptoms, understanding who is most at risk allows for early detection, timely treatment, and reduced complications. Whether it's viral infections, autoimmune conditions, or treatment side effects, recognizing red flags in vulnerable groups is essential for preventing severe outcomes.

Individuals with any of the above risk factors should be proactive about reporting symptoms like chest pain, fever, or shortness of breath and seeking prompt medical attention.