Pericarditis is an inflammation of the pericardium or sac that contains your heart. Most people do well with prompt treatment, rest and medication. Others may need a procedure to drain fluid from their pericardium. In most cases, people make a full recovery. However, it can take weeks or months.
A complication of a viral infection, most often a gastrointestinal virus, causes viral pericarditis.
A bacterial infection, including tuberculosis, causes bacterial pericarditis.
A fungal infection causes fungal pericarditis.
An infection from a parasite causes parasitic pericarditis.
Some autoimmune diseases, such as lupus, rheumatoid arthritis and scleroderma, can cause pericarditis.
Injury to the chest, such as after a car accident, causes traumatic pericarditis.
Kidney failure causes uremic pericarditis.
Tumors like lymphoma causes malignant pericarditis.
Genetic diseases such as Familial Mediterranean Fever (FMF).
Medications that suppress the immune system.
Types of Pericarditis
Acute pericarditis: Inflammation of the pericardium that develops suddenly along with the sudden onset of symptoms.
Chronic pericarditis: Inflammation of the pericardium that lasts for three months or longer after the initial acute attack.
Constrictive pericarditis: A severe form of pericarditis in which the inflamed layers of the pericardium stiffen, develop scar tissue, thicken and stick together. Constrictive pericarditis interferes with your heart’s normal function. This usually happens after multiple episodes of acute pericarditis over time.
Infectious pericarditis: develops as the result of a viral, bacterial, fungal or parasitic infection.
Idiopathic pericarditis: Pericarditis that doesn’t have a known cause.
Traumatic pericarditis: develops as the result of an injury to the chest, such as after a car accident.
Uremic pericarditis: develops as the result of kidney failure.
Malignant pericarditis: develops as result of a cancer growing in your body.
Pericarditis symptoms include chest pain that:
Is sharp and stabbing (This happens when your heart rubs against your pericardium).
May get worse when you cough, swallow, take deep breaths or lie flat.
Feels better when you sit up and lean forward.
You also may feel the need to bend over or hold your chest to breathe more comfortably.
Other pericarditis symptoms include:
Pain in your back, neck or left shoulder.
Trouble breathing when you lie down.
A dry cough.
Palpitations (feeling like your heart is racing or beating irregularly).
Anxiety or fatigue.
Swelling of your legs, feet and ankles in severe cases.
Chest X-ray to see the size of your heart and any fluid in your lungs.
Electrocardiogram (ECG or EKG) to look for changes in your heart rhythm. In about half of all people with pericarditis, providers see some characteristic changes to a normal heart rhythm. Some people don’t have any changes. If they do, they may be temporary.
Echocardiogram (echo) to see how well your heart is working and check for fluid (a pericardial effusion) around your heart. An echo will show the classic signs of constrictive pericarditis, including a stiff or thick pericardium that constricts your heart’s normal movement.
Cardiac MRI to check for extra fluid in your pericardium, pericardial inflammation or thickening, or compression of your heart. Your provider will give you a contrast agent called gadolinium during this highly specialized test.
CT scan to look for calcium in the pericardium, fluid, inflammation, tumors and disease of the areas around your heart. Your provider uses iodine dye during the test to get more information about the inflammation. This is an important test for patients who may need surgery for constrictive pericarditis.
Cardiac catheterization to get information about the filling pressures in your heart. This test can confirm a diagnosis of constrictive pericarditis.
Blood tests can help your provider make sure you’re not having a heart attack, see how well your heart is working, test the fluid in the pericardium and help find the cause of pericarditis. If you have pericarditis, it is common for your sedimentation rate (ESR) and ultra-sensitive C reactive protein levels (markers of inflammation) to be higher than normal.
Treatment for acute pericarditis may include medication for pain and inflammation, such as ibuprofen or high-dose aspirin. Depending on the cause of your pericarditis, you may need an antibiotic or antifungal medication.
If you have severe symptoms that last longer than two weeks, or they clear up and then return, your healthcare provider may also prescribe an anti-inflammatory drug called colchicine.
Colchicine can help control the inflammation and prevent pericarditis from returning weeks or even months later.
Your provider may also prescribe a steroid medicine called prednisone, especially if you have kidney disease that makes it difficult for you to take ibuprofen and colchicine.
When fluid builds up in the space between the pericardium, it can cause a condition called pericardial effusion.
If the fluid builds up quickly, it can cause cardiac tamponade, a severe compression of the heart that impairs its ability to function.
Cardiac tamponade is a medical emergency that requires prompt diagnosis and treatment.
If you have constrictive pericarditis, you may need to have some of your pericardium removed.
This surgery is called a pericardiectomy.
Surgeons perform this on people who develop scar tissue in their pericardium.
It’s not normally for people who have active inflammation and chest pain from pericarditis.