Pericarditis: Symptoms, Causes, Diagnosis, Treatment & Prevention

 

Pericarditis is an inflammation of the sac around your heart. The predominant symptom is sharp chest discomfort that is relieved by leaning forward. Pericarditis can be caused by a variety of conditions, including infections and chest injuries. However, in many cases, healthcare providers are unable to identify the main cause. Prompt treatment is crucial.

Pericarditis is the swelling and irritation of the thin, sac-like tissue that surrounds the heart. This tissue is known as the pericardium. Pericarditis frequently results in acute chest discomfort. Chest pain develops when the inflamed layers of the pericardium rub against each other.

Pericarditis is generally mild. It might go away without treatment. More serious symptoms may be treated with medications or, in rare cases, surgery. Early detection and treatment of pericarditis may help reduce the risk of long-term complications.

                                                                         

                               

What is Pericarditis?

 An example of the inflamed pericardium, the heart's double-layered sac

 Pericarditis typically appears out of nowhere and might linger for weeks or months.  Sharp chest discomfort is frequently the result.

 Inflammation of the pericardium, the thin sac that surrounds your heart, is known as pericarditis.  It can endure for weeks or months and often manifests swiftly.  Sharp chest discomfort is the primary symptom.

 Anyone can get pericarditis.  However, guys between the ages of 16 and 65 are more likely to experience it.  This illness is thought to affect 28 out of every 100,000 persons per year.  It is often treatable.

Also Read: Heart attack: Symptoms, Causes, Treatment & Prevention

Types:

Depending on its duration and the underlying cause, there are several forms of pericarditis.

Depending on the length or time, types consist of:

• Acute pericarditis: It appears abruptly and lasts for less than four to six weeks.

• Subacute pericarditis: The symptoms disappear in three months after lasting longer than four to six weeks.

• After the initial attack, chronic pericarditis persists for more than three months.

• Recurrent pericarditis: It reappears following the first course of therapy. Up to 30% of the time, this is the case.

Types according to the cause consist of:

•  The etiology of idiopathic pericarditis is unknown.

•  Infectious pericarditis is brought on by a bacterial, fungal, viral, or parasitic infection.

•  Malignant pericarditis: This is brought on by cancer in another part of your body.

•  A chest injury, such as one sustained in an automobile collision, can result in traumatic pericarditis.

•  Kidney failure is the cause of uremic pericarditis.

•  A complication of several forms of pericarditis is constrictive pericarditis.  It occurs when the sac's layers adhere to one another, harden, and leave scars.  This is a severe form.

Pericarditis symptoms:

One of the most prevalent signs of pericarditis is chest discomfort. The pain is searing and acute. Coughing, swallowing, deep breathing, and lying flat frequently make it worse. Leaning forward and sitting up can help. These particular symptoms frequently indicate pericarditis rather than a heart attack. Your left shoulder, neck, or back may also experience pain.


Additional signs of pericarditis include:

• Trouble breathing when lying down

• Dry cough, Palpitations, or racing or irregular heartbeat

• Fever and Fatigue

• Ankle, foot, and leg swelling (in extreme instances)

• Contact a physician immediately if you have any of these symptoms.

What is the main cause of pericarditis:

 There are several potential causes of pericarditis.  The most frequent causes of acute pericarditis in Western Europe and North America are viral or unknown (idiopathic).

 Healthcare professionals classify causes as either infectious or non-infectious.

 Among the infectious causes are:

•  Adenoviruses, HIV, COVID-19, influenza, and other viruses

•  Similar to TB, bacteria

•  Parasites and fungi (very rare)

 Non-infectious reasons include, for instance:

•  Chest injuries or surgery

•  Cancer in another part of your body

•  Rheumatoid arthritis and lupus are examples of autoimmune diseases.

•  Uremia is a consequence of untreated kidney failure.

•  Myxedema, or severe hypothyroidism

Risk factors:

Pericarditis is more likely to occur after:

• Dressler's syndrome, or a heart attack

• Surgery on the open heart (postpericardiotomy syndrome)

• Radiation therapy

Additional therapies, such as radiofrequency ablation (RFA) or cardiac catheterization

Complications:

Pericardial effusion is a condition that can arise from excessive fluid accumulation in the pericardium. Cardiac tamponade may result if the fluid accumulates rapidly. Your heart is severely compressed, which prevents it from functioning normally. There is a medical emergency.

For this reason, if you experience pericarditis symptoms, it's critical to consult a doctor once. Early intervention can help prevent these issues.

 How do you diagnosis pericarditis:

A healthcare provider will ask about your symptoms and medical history (such as if you have recently been unwell). They will examine your medical history and surgical history to identify risk factors.

Your provider will listen to your heart. Inflamed tissue produces a rubbing or cracking sound known as the "pericardial rub." They may also notice crackles in your lungs if fluid has accumulated.

Your doctor may recommend further testing to confirm a pericarditis diagnosis. These tests can also detect problems and assist determining their cause. Tests can include:

• Chest X-ray can reveal the size of your heart and any fluid in your lungs.

• Electrocardiogram (ECG or EKG) to detect changes in your heart rhythm

• Echocardiogram to see how well your heart is operating and check for excess fluid surrounding it.

• Cardiac MRI to check for pericardial inflammation, thickness, or compression of your heart.

• CT scan to check for calcium in your pericardium, malignancies, and illness in the tissues surrounding your heart

• Cardiac catheterization to learn about the filling pressures in your heart and confirm constrictive pericarditis

• Blood testing can help confirm or rule out pericarditis and perhaps find the cause.

How is it treated?

Pericarditis is often treated with medications and limited activity. If the condition is serious, you may require fluid drainage and/or surgery.


Medication

Most persons with acute pericarditis just require medication, such as:

• NSAIDs: Ibuprofen or high-dose aspirin can relieve symptoms.

• Antibiotics and antifungal medications can be used to treat underlying infections.

• Colchicine (Colcrys®, Gloperba®) is an anti-inflammatory drug. Your doctor may prescribe it if you have symptoms for more than two weeks or if they return.

• Prednisone is a steroid that your doctor may prescribe if you cannot take ibuprofen or colchicine.

Depending on the cause of your pericarditis, you may require other medications.

If you have chronic or recurring pericarditis, you may need to take NSAIDs or colchicine for several years, even if you feel well.

Physical Activity Limitations

It's important to rest while recovering from pericarditis. Physical activity can worsen the inflammation. Your healthcare professional will tell you how much and how long you should limit your physical activity.

Gradually getting back to movement is also important for preventing pericarditis from recurring.

Fluid Drainage

If fluid accumulates in your pericardium and presses on your heart, you may need a pericardiocentesis. To drain the excess fluid, your provider uses a long, thin tube.

If the fluid cannot be drained with a needle, your provider will perform a pericardial window procedure. To drain the fluid, they will make a small chest incision and open your pericardium.

Surgery

If you have constrictive pericarditis, you may need to have part of your pericardium removed. This surgery is known as a pericardiectomy.

If you have recurring pericarditis, surgery is usually not a treatment option. This is because inflammation impedes post-operative recovery. However, if other therapies are unsuccessful, your doctor may discuss it with you.

Prevention:

There is no precise strategy to prevent pericarditis. However, you can take the following precautions to prevent infections, which may help reduce the risk of heart inflammation:

• Avoid those who have a viral or flu-like sickness until they have recovered. If you have symptoms of a viral infection, avoid exposing others. For example, cover your mouth when you sneeze or cough.

• Maintain good hygiene. Handwashing regularly can help prevent the spread of sickness. Wash your hands with soap and water for at least 20 seconds.

• Get the appropriate vaccines. Keep up with the recommended vaccinations, such as those that protect against influenza, rubella, and COVID-19. These are examples of viral diseases that can result in myocarditis, an inflammation of the heart muscle. A viral infection can cause both myocarditis and pericarditis. Pericarditis and myocarditis are rare side effects of the COVID-19 vaccination, particularly in males aged 12 to 17. Discuss the advantages and disadvantages of vaccinations with your healthcare provider.

References:

• Dababneh E, Siddique MS. Pericarditis (https://www.ncbi.nlm.nih.gov/books/NBK431080/). 2025 Jul 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Accessed 9/19/2025.

• Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS) (https://pubmed.ncbi.nlm.nih.gov/26320112/). Eur Heart J. 2015 Nov;36(42):2921-64. Accessed 9/19/2025.

• Ferri FF. Pericarditis. In: Ferri's Clinical Advisor 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed April 21, 2020.

• National Heart, Lung, and Blood Institute (U.S.). Pericarditis (https://www.nhlbi.nih.gov/health/heart-inflammation/pericarditis). Last updated 10/10/2023. Accessed 9/19/2025.

• Cremer PC, Klein AL, Imazio M. Diagnosis, Risk Stratification, and Treatment of Pericarditis: A Review (https://pubmed.ncbi.nlm.nih.gov/39235771/). JAMA. 2024 Oct;332(13):1090-1100. Accessed 9/19/2025.

• Myocarditis and pericarditis after mRNA COVID-19 vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html. Accessed Nov. 29, 2021.

• Echocardiogram (echo). American Heart Association. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/echocardiogram-echo. Accessed Dec. 8, 2023.

• American Heart Association. What Is Pericarditis? (https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis) Last reviewed 6/6/2024. Accessed 9/19/2025.

• AskMayoExpert. Acute pericarditis. Mayo Clinic; 2020.