Pericarditis

Overview

Pericarditis is swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium). Pericarditis often causes sharp chest pain. The chest pain occurs when the irritated layers of the pericardium rub against each other.

Pericarditis is usually mild and goes away without treatment. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help reduce the risk of long-term complications from pericarditis.

Symptoms

Chest pain is the most common symptom of pericarditis. It usually feels sharp or stabbing. However, some people have dull, achy or pressure-like chest pain.

Pericarditis pain usually occurs behind the breastbone or on the left side of the chest. The pain may:

• Spread to the left shoulder and neck
• Get worse when coughing, lying down or taking a deep breath
• Get better when sitting up or leaning forward

Other signs and symptoms of pericarditis may include:

• Cough
• Fatigue or general feeling of weakness or being sick
• Leg swelling
• Low-grade fever
• Pounding or racing heartbeat (heart palpitations)
• Shortness of breath when lying down
• Swelling of the belly (abdomen)

The specific symptoms depend on the type of pericarditis. Pericarditis is grouped into different categories, according to the pattern of symptoms and how long symptoms last.

• Acute pericarditis begins suddenly but doesn't last longer than three weeks. Future episodes can occur. It may be difficult to tell the difference between acute pericarditis and pain due to a heart attack.
• Recurrent pericarditis occurs about four to six weeks after an episode of acute pericarditis with no symptoms in between.
• Incessant pericarditis lasts about four to six weeks but less than three months. The symptoms are continuous.
• Chronic constrictive pericarditis usually develops slowly and lasts longer than three months.

When to see a doctor

Seek immediate medical care if you develop new symptoms of chest pain.

Many of the symptoms of pericarditis are similar to those of other heart and lung conditions. It's important to be thoroughly evaluated by a health care provider if you have any type of chest pain.

Causes

The cause of pericarditis is often hard to determine. A cause may not be found (idiopathic pericarditis).

Pericarditis causes can include:

• Immune system response after heart damage due to a heart attack or heart surgery (Dressler syndrome, also called postmyocardial infarction syndrome or postcardiac injury syndrome)
• Infection, such as COVID-19
• Inflammatory disorders, including lupus and rheumatoid arthritis
• Injury to the heart or chest
• Other chronic health conditions, including kidney failure and cancer

Complications

Early diagnosis and treatment of pericarditis usually reduces the risk of complications. Potential complications of pericarditis include:

• Fluid buildup around the heart (pericardial effusion). The fluid buildup can lead to further heart complications.
• Thickening and scarring of the heart lining (constrictive pericarditis). Some people with long-term pericarditis develop permanent thickening and scarring of the pericardium. The changes prevent the heart from filling and emptying properly. This unusual complication often leads to severe swelling of the legs and abdomen and shortness of breath.
• Pressure on the heart due to fluid buildup (cardiac tamponade). This life-threatening condition prevents the heart from filling properly. Less blood leaves the heart, causing a dramatic drop in blood pressure. Cardiac tamponade requires emergency treatment.

Prevention

There's no specific prevention for pericarditis. However, taking these steps to prevent infections might help reduce the risk of heart inflammation:

• Avoid people who have a viral or flu-like illness until they've recovered. If you're sick with symptoms of a viral infection, try to avoid exposing others.
• Follow good hygiene. Regular hand-washing can help prevent spreading illness.
• Get recommended vaccines. Stay up to date on the recommended vaccines, including those that protect against COVID-19, rubella and influenza — diseases that can cause myocarditis. Rarely, the COVID-19 vaccine can cause inflammation of the outer heart lining (pericarditis) and inflammation of the heart muscle, especially in males ages 12 through 17. Talk to your health care provider about the benefits and risks of vaccines.