What Is the Best Treatment for Pericarditis?

Pericarditis is a condition in which the sac that surrounds the heart becomes inflamed. The best treatment for pericarditis depends on what's causing the infection. Antivirals, corticosteroids and surgery may be used.

Pericarditis is a condition in which the protective sac around the heart becomes inflamed. This sac is called the pericardium. The prefix “peri” means around, “cardium” means heart, and “the suffix “itis” means inflammation.

This protective sac has two layers. The first fits around the heart. The second keeps the heart in place inside the ribcage, with connecting tissue that attaches to the diaphragm. Pericarditis occurs when the area between these two layers becomes inflamed.

Pericarditis can be:

• Acute – This is essentially a one-time case of pericarditis. The condition may become apparent over hours or a couple of weeks.
• Recurrent – Pericarditis may occur again in the future for some people. In between instances of inflammation, you would not show any symptoms and the tissue in the pericardium would not be inflamed. 
• Chronic – An estimated 15–30% of cases will be diagnosed as chronic. This means that the inflammation will linger for weeks or months, even with treatment.

Chest pain is the most common symptom of pericarditis. This pain may not be limited to the chest cavity. Instead, it may spread through your neck, shoulders, back, and stomach. The pain may worsen when you take deep breaths or when you lie down. You may also experience an increase in coughing and difficulty swallowing.

Patients usually describe the pain as sharp or stabbing. When you sit up or lean forward, the pain may lessen. Your chest pain will be accompanied by fever, chills, or sweating. Other conditions can cause similar symptoms, so it is important to talk to your doctor so you can get an accurate diagnosis.

Other symptoms may include:

• Swelling in the lower half of your body
• Unexplained feelings of anxiety
• Difficulty breathing when you lie down
• Dry cough
• Fatigue or tiredness 

Viruses usually cause pericarditis. Since the respiratory tract is so near the heart, inflammation can often spread into the pericardium sac surrounding the heart.

In other cases, other heart-related issues like a heart attack or heart surgery can cause pericarditis. Additional causes of pericarditis include:

• Cancer
• Autoimmune disorders
• HIV/AIDS
• Underactive thyroid
• Kidney failure
• Tuberculosis
• Certain medications
• Radiation therapy

Anyone with a condition listed above is particularly at risk to develop pericarditis, but it can affect people of all ages. However, men between the ages of 20 and 50 are most at risk for developing the condition.

If more than one case of pericarditis is diagnosed within 18 months, the risk of a future case rises by 25–50%. This means that there is an increased chance the condition will continue to impact a person repeatedly throughout their life.

To provide a diagnosis, your doctor will ask for details about your symptoms and examine your recent medical history. He or she will take your blood pressure, temperature, and then listen to your breathing and heartbeat.

Additional tests may include:

• EKG
• Chest X-ray
• Echocardiogram
• Blood tests to assess inflammation

The best treatment plan for your case of pericarditis will depend on what caused your infection. Rest is very important for recovery, and over-the-counter anti-inflammatory medications will often help to reduce your inflammation, also alleviating your symptoms. 

When your symptoms ease, even temporarily, your body has the chance to heal from the damage that occurs during a viral infection. If over-the-counter medication isn’t strong enough, your doctor may prescribe a similar medication in a higher dose. 

While non-steroidal options are the first choice of many doctors, you may need the additional help of a corticosteroid, which speeds up the healing process. This is especially important for patients with autoimmune disorders.

While viral infections typically require time and patience, a bacterial infection will require a more aggressive treatment. Your doctor may prescribe a strong antibiotic and in some cases may refer you to a specialist for further analysis. 

If your heart function is impacted by pericarditis, surgery may be necessary to remove any infected fluid in the pericardium layer. A cardiologist can perform more detailed scans and tests to determine the severity of your infection. 

Remember, unexplained chest pain is always a reason to talk to your doctor. If you do receive a pericarditis diagnosis, you can expect to make a full recovery in two to four weeks with proper treatment.