What is pericarditis?

Pericarditis is an inflammation of the tissue called the pericardium, that surrounds your heart. Sometimes your pericardium can weaken enough that it develops infection and inflammation.
Pericarditis is an inflammation of the tissue called the pericardium, that surrounds your heart. Sometimes your pericardium can weaken enough that it develops infection and inflammation.

Pericarditis is an inflammation of the tissue that surrounds your heart. This tissue, a fluid-filled sac called the pericardium, protects your heart from over-expanding, keeps your heart lubricated, and allows your heart to work properly. Sometimes your pericardium can weaken enough that it develops infection and inflammation.

In pericarditis, the pericardium becomes inflamed and may begin to fill with blood, pus, or clear fluid. This condition can be painful, with a sharp pain in your chest and pressure that can spread to your arm or shoulder. Although pericarditis is not a heart attack, the chest pain symptoms can resemble those of a heart attack, so it's important to have a doctor check you over. 

This condition, which can be acute or chronic, can affect men and women of any age. About 65% of the time it affects men between ages 18 and 65. Men between 40 and 60 have the highest chance of developing an acute form of pericarditis. 

It's important to know the symptoms and causes of this condition so you can seek the best treatment options for your needs.

Signs and symptoms of pericarditis

Pericarditis can cause many symptoms or only a few symptoms, depending on which type it is and what caused the inflammation. You should head to a clinic or emergency department if you have any chest pains to ensure that you aren't experiencing a heart attack. Other symptoms of pericarditis can also indicate serious complications that may need immediate treatment.

These are the signs and symptoms you may experience with pericarditis:

Chest pain

Chest pain on your left side happens in acute and chronic pericarditis. It may feel worse when you lie back, cough, or take deep breaths. This feeling tends to improve when you lean forward or sit up. The chest pain can be constant, or it can have more sharp and stabbing sensations. These sharp, intense chest pains are more common with acute pericarditis.

Breathing troubles

You may have more difficulties with breathing, especially when you're lying down. Typically, you feel more pain when taking breaths, and you may experience shortness of breath

Swollen neck veins

Swollen neck veins are common in both acute and chronic pericarditis. The acute form also tends to cause a significant drop in blood pressure, known as pulsus paradoxus, during cardiac tamponade when the sac fills with fluid.

Swollen legs and abdomen

You may also experience swelling in your legs and abdomen as fluid builds up. This swelling tends to occur in chronic pericarditis. Leg swelling in pericarditis may also indicate that the pericardium has thickened and hardened.

Fever and weakness

Fever and weakness are also common in some types of pericarditis. Along with general malaise, you may experience sweating and chills that resemble symptoms of the flu.

Abnormal heartbeat

Heart palpitations may include a racing heart, skipping beats, or a general fluttering. These palpitations occur with all forms of pericarditis and may begin to affect your overall heart health.

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Types of pericarditis

There are two main types of pericarditis: acute and chronic.

Acute pericarditis

This type of pericarditis comes on suddenly and has noticeable chest pain. Acute pericarditis often results from infections, heart surgery, autoimmune disorders, medication, and radiation therapy. Most cases of acute pericarditis resolve in about 3 to 6 weeks.

Chronic pericarditis

In chronic pericarditis, your symptoms develop over a period of 6 months or longer. This form can develop from chronic kidney disease, cancer, hypothyroidism, infections, or heart surgery.

Causes of pericarditis

Sometimes the cause of pericarditis is unknown, but in most cases, doctors attribute pericarditis to a few main causes:

Infection

Any type of infection, from viral to fungal to bacterial, can cause inflammation of the pericardium. Tuberculosis and HIV/AIDS also increase your risk for developing pericarditis.

Autoimmune disorders

Autoimmune disorders, such as lupus, scleroderma, and rheumatoid arthritis, can be a contributing cause of pericarditis. These disorders tend to lead to chronic forms of the condition but may develop in acute pericarditis as well.

Chest injury

Injuries to the chest can damage the pericardium and cause inflammation. You may also develop pericarditis from tissue damage that occurs during radiation therapy.

Surgery

Heart surgery is one of the more common causes of pericarditis. Pericarditis after surgery is known as postpericardiotomy syndrome, and it can occur from 1 to 6 weeks after your procedure.

Medication

Some types of medications can cause this condition, especially penicillin, anti-seizure medications, anticoagulants like heparin or warfarin, and irregular heartbeat medications.

Diagnosing pericarditis

Your doctor will ask you about your symptoms and begin a physical exam to listen for fluid buildup or a sound called the pericardial rub. They may order tests to help rule out other conditions and assess how serious your condition may be. These tests may include blood tests, a chest x-ray, an echocardiogram (EGG), and an electrocardiogram (ECG or EKG). Depending on results, they may order a cardiac magnetic resonance imaging (MRI) or cardiac computerized tomography (CT) scan as well.

Treatments for pericarditis

Treatment for pericarditis depends on the type and whether you've developed any complications. Milder cases may require rest, pain medications, and anti-inflammatory medications. You'll receive antibiotics if you have a bacterial infection.

In more serious cases of pericarditis, you may also need fluid drainage to relieve the pressure on your heart. If you don't respond to other treatments and have developed chronic pericarditis, your doctor may recommend surgery to remove the pericardium itself.

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Medically Reviewed on 1/11/2021
References
Acta Clinica Croatica: "Postpericardiotomy syndrome incidence, diagnostic and treatment strategies: experience AT two collaborative centers."

American Heart Association: "Prevention and Treatment of Pericarditis."

American Heart Association: "Symptoms and Diagnosis of Pericarditis."

American Heart Association: "What is Pericarditis?"

Cedars-Sinai: "Pericarditis."

Circulation: "Clinical Profile and Influences on Outcomes in Patients Hospitalized for Acute Pericarditis."

European Respiratory Journal: "Pulsus paradoxus."

Heart and Stroke Foundation of Canada: "Pericarditis."

Merck Manual: "Acute Pericarditis."

Merck Manual: "Chronic Pericarditis."

Radiology and Oncology: "Pericardial Disease after Breast Cancer Radiotherapy."

Victoria State Government Better Health Channel: "Pericarditis."

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