Diagnosis

Your doctor likely will start by taking your medical history and asking questions about your chest pain and other symptoms. As part of your initial evaluation, your doctor will also perform a physical exam and check your heart sounds.

While listening to your heart, your doctor will place a stethoscope on your chest to check for the sounds characteristic of pericarditis, which are made when the pericardial layers rub against each other. This characteristic noise is called a pericardial rub.

Your doctor may have you undergo tests that can help determine whether you've had a heart attack, whether fluid has collected in the pericardial sac or whether there are signs of inflammation. Your doctor may use blood tests to determine if a bacterial or other type of infection is present.

You may also undergo one or more of the following diagnostic procedures:

  • Electrocardiogram (ECG). In this test, patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart.

    Impulses are recorded as waves displayed on a monitor or printed on paper. Certain ECG results may indicate pericarditis, while others could indicate a heart attack.

  • Chest X-ray. With an X-ray of your chest, your doctor can study the size and shape of your heart. Images of your heart may show an enlarged heart if excess fluid has accumulated in the pericardium.
  • Echocardiogram. This test uses high-frequency sound waves to create an image of your heart and its structures, including fluid accumulation in the pericardium. Your doctor can view and analyze this image on a monitor.
  • Computerized tomography (CT). This X-ray technique can produce more-detailed images of your heart and the pericardium than can conventional X-ray studies.

    CT scanning may be done to exclude other causes of acute chest pain, such as a blood clot in a lung artery (pulmonary embolus) or a tear in your aorta (aortic dissection). CT scanning can also be used to look for thickening of the pericardium that might indicate constrictive pericarditis.

  • Cardiac magnetic resonance imaging (MRI). This technique uses a magnetic field and radio waves to create cross-sectional images of your heart that can reveal thickening, inflammation or other changes in the pericardium.

Treatment

Treatment for pericarditis depends on the cause as well as the severity. Mild cases of pericarditis may get better on their own without treatment.

Medications

Medications to reduce the inflammation and swelling associated with pericarditis are often prescribed, including:

  • Pain relievers. Most pain associated with pericarditis responds well to treatment with pain relievers available without a prescription, such as aspirin or ibuprofen (Advil, Motrin IB, others). These medications also help lessen inflammation. Prescription-strength pain relievers also may be used.
  • Colchicine (Colcrys, Mitigare). This drug, which reduces inflammation in the body, may be prescribed for acute pericarditis or as a treatment for recurrent symptoms.

    Colchicine can reduce the length of pericarditis symptoms and decrease the risk that the condition will recur. However, the drug is not safe for people with certain pre-existing health problems, such as liver or kidney disease, and for those taking certain medications. Your doctor will carefully check your health history before prescribing colchicine.

  • Corticosteroids. If you don't respond to pain relievers or colchicine or if you have recurrent symptoms of pericarditis, your doctor may prescribe a steroid medication, such as prednisone.

Acute episodes of pericarditis typically last a few weeks, but future episodes can occur. Some people with pericarditis have a recurrence within months after the original episode.

When a bacterial infection is the underlying cause of pericarditis, you'll be treated with antibiotics and drainage if necessary.

Hospitalization and procedures

You'll likely need hospitalization if your doctor suspects cardiac tamponade, a dangerous complication of pericarditis due to fluid buildup around the heart.

If cardiac tamponade is present, your doctor may recommend a procedure to relieve fluid buildup, such as:

  • Pericardiocentesis. In this procedure, a doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You'll receive a local anesthetic before undergoing pericardiocentesis, which is often done with echocardiogram monitoring and ultrasound guidance. This drainage may continue for several days during the course of your hospitalization.
  • Pericardiectomy. If you're diagnosed with constrictive pericarditis, you may need to undergo a surgical procedure (pericardiectomy) to remove the entire pericardium that has become rigid and is making it hard for your heart to pump.

Lifestyle and home remedies

For most mild cases of pericarditis, rest and over-the-counter pain medications — taken under your doctor's direction — may be all that's needed. While you recuperate, avoid rigorous physical activity. Strenuous activity can trigger pericarditis symptoms. Ask your doctor how long you need to take it easy.

Preparing for your appointment

You're likely to start by seeing your family doctor or an emergency room physician. In some cases when you call to set up an appointment, you may be referred to a doctor trained in diagnosing and treating heart conditions (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

  • Write down any symptoms you're experiencing and for how long. Also note if you've had similar symptoms that have come and gone in the past.
  • Make a list of your key medical information, including other recent health problems you've had and the names of any prescription and over-the-counter medications you're taking.
  • Find a family member or friend who can come with you to the appointment, if possible. Someone who accompanies you can help remember what the doctor says.
  • Write down the questions you want to be sure to ask your doctor.

For pericarditis, some basic questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • What kinds of tests do I need? Will I need to be hospitalized for testing?
  • What treatment approach do you recommend?
  • How soon after I begin treatment can I expect improvement in my symptoms?
  • What are the possible side effects of the treatments you're prescribing?
  • Am I at risk of long-term complications from this condition?
  • How often will I need follow-up appointments for this condition?
  • Do I need to follow any activity or diet restrictions?
  • Are there any special guidelines for managing this condition along with my other health conditions?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

  • Can you describe your symptoms? Where is the pain? How severe is the pain?
  • Did your symptoms come on gradually or suddenly? When?
  • Have you had similar symptoms in the past?
  • Are you having any difficulty breathing?
  • Does changing your position affect your pain?
  • Have you recently had a cold or the flu? What about a fever?
  • Have you recently lost weight without trying?
  • Do any of your first-degree relatives — parents, siblings or children — have a history of heart disease?
  • Do you or did you smoke? How much?