What is pericarditis?
Pericarditis is inflammation of the pericardium, a stretchy sac-like cover surrounding your heart.
The pericardium consists of two layers of thin tissue with a small amount of fluid between them. It protects your heart from infection and from rubbing on surrounding tissues when it beats, which can cause irritation. When the pericardium becomes irritated, it becomes inflamed, and pericarditis develops.
Types of pericarditis
There are different types of pericarditis, with variations depending on how it develops:
- Infectious pericarditis: Developing as a result of a viral, bacterial or other infection.
- Traumatic pericarditis: Developing as a result of trauma to the chest, such as after a car accident.
- Idiopathic pericarditis: Developing without a clear-cut or definitive cause.
- Constrictive pericarditis: Scar tissue develops in the pericardium, causing the tissue to thicken and lose its elasticity. This type may lead to long-term issues resembling heart failure.
- Effusive-constrictive pericarditis: When fluid builds up in the pericardium.
Symptoms of pericarditis
Acute pericarditis
The most common symptom of acute pericarditis is sharp, stabbing chest pain in the middle or on the left side of the chest. Pain may radiate to one or both shoulders. Other symptoms may include:
- Coughing
- Difficulty breathing
- Feeling that your heart is beating too fast, fluttering or skipping a beat (arrhythmia)
- Fever
- Weakness
Symptoms may get better if you sit up and lean forward and get worse when you breathe deeply or lie down.
Acute pericarditis isn’t usually life-threatening, but the symptoms are similar to heart attack symptoms. Seek medical help immediately if you experience sudden chest pain.
Chronic pericarditis
Chronic pericarditis may cause chest pain but not always. Common symptoms include:
- Coughing
- Extreme tiredness for no known reason
- Shortness of breath
- Swelling in the ankles, feet, legs or stomach
Recurrent pericarditis
Recurrent pericarditis may cause a dull or stabbing pain or pressure in the chest. Like acute pericarditis, these symptoms often change as your breathing or position changes.
Other possible symptoms include:
- Coughing
- Difficulty breathing or shortness of breath
- Dizziness, lightheadedness or fainting
- Fast or fluttering heartbeat
- Fever
- Low blood pressure
- Swelling in the belly, ankles, feet or legs
Risk factors for pericarditis
Anyone can develop pericarditis.
Different factors may cause pericarditis, and it is not uncommon for a single, exact cause to remain unknown. Some causes include:
- Bacterial infections
- Cancer
- Certain medications, including some blood thinners and anti-seizure drugs
- Injury or trauma to the chest
- Kidney failure
- Viral infections, such as COVID-19 and pneumonia
Additionally, chronic and recurrent pericarditis can be caused by autoimmune disorders, conditions in which the body attacks healthy tissue, or other conditions that affect the immune system, such as:
- Human immunodeficiency virus (HIV) or AIDS
- Lupus
- Rheumatoid arthritis
- Scleroderma
Your risk of pericarditis is higher after:
- A heart attack
- Open heart surgery
- Radiation therapy
- Percutaneous treatment, such as cardiac catheterization or radiofrequency ablation (RFA)
What are the complications of pericarditis?
- Pericardial effusion: Occurs when fluid builds up in the pericardium.
- Constrictive pericarditis: Occurs when the pericardium becomes thick and stiff. This can happen due to inflammation or scarring, making it harder for the heart to fill with blood properly.
- Cardiac tamponade: Occurs when fluid builds up in the sac around the heart and puts pressure on the heart, making it difficult for the heart to pump blood effectively. This is a medical emergency.
How is pericarditis diagnosed?
To diagnose pericarditis, your provider will ask you about your medical history, including any recent injuries, illnesses or infections. They will also ask you to describe your symptoms and if anything makes symptoms better or worse.
Your provider will carry out a physical exam and listen to your heart. They may hear the heart and pericardium rubbing together or sounds caused by excess fluid in the lungs or pericardium.
Based on your exam, your provider may order one of the following diagnostic tests to gather more information.
Blood tests
Different types of blood tests may be done to measure specific enzyme and protein levels that might indicate inflammation or infection.Cardiac imaging
Cardiac imaging uses chest X-ray, CT, MRI or positron emission tomography to take detailed images of your heart, the pericardium, and nearby blood vessels and tissues. The tests can also show how well blood moves through your heart.Echocardiogram
An echocardiogram is an imaging test that uses high-frequency sound waves to show your heart’s functionality.Electrocardiogram
An electrocardiogram (ECG) measures your heart’s electrical activity. If an ECG picks up unusual activity, it can be a sign of irregular heartbeats related to pericarditis.Treating pericarditis
With treatment, most people recover fully from pericarditis without complications.
Treatment varies based on the cause, severity and type. The main goals of treatment are to:
- Decrease pain
- Reduce inflammation
- Treat the underlying cause when known
- Watch for and prevent complications
If your cardiologist can uncover what’s causing your pericarditis, getting treatment for that condition may be all you need.
If the cause is unknown, your treatment may include medications to reduce inflammation or manage symptoms. Your cardiologist will likely recommend rest and activity restrictions.
If fluid buildup in the pericardium affects your heart’s function, you may need surgery to drain the excess fluid. Often, cardiac surgeons can make an incision in the pericardium and allow fluid to drain into the abdomen.
Find a location near you
With advanced pericarditis care, we can lower your risk of complications and help you return to your usual routine. We can help you get the care you need to treat and recover from pericarditis at a location that fits your needs. Our cardiologists are available at many locations, including our specialized locations across North and Central Texas.
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