Pericarditis (English: peri8xcar8xdit8xis) is swelling and irritation of the thin, sac-like tissue surrounding the heart (pericardium). Pericarditis often causes sharp chest pain and sometimes other symptoms. 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 of pericarditis
Chest pain is the most common symptom of pericarditis. You usually feels a sharp or stabbing pain. However, some people have dull, achy or pressure-like chest pain.
- The pain usually occurs behind the breastbone or in the left side of your chest.
- The pain may spread to your left shoulder and neck.
- The pain often gets worse when you cough, lie down or take a deep breath.
- Sitting up and leaning forward makes you feel better.
Other signs and symptoms of pericarditis may include:
- Abdominal swelling or leg swelling
- Fatigue or feeling of weakness or being sick
- Low-grade fever
- Pounding or racing heartbeat (heart palpitations)
- Shortness of breath when lying down
The specific symptoms you have depend on the type of pericarditis you have. 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 do you need 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 symptoms of other heart and lung diseases. The sooner you are evaluated, the sooner you can receive proper diagnosis and treatment. For example, although the cause of acute chest pain may be pericarditis, the original cause could have been a heart attack or a blood clot of the lungs (pulmonary embolus).
Causes of pericarditis
The cause of pericarditis is often hard to determine. Sometimes, doctors can’t find a cause (idiopathic pericarditis).
Pericarditis causes can include:
- Heart attack or heart surgery, which may trigger pericarditis or delayed pericarditis (Dressler’s syndrome, also called postmyocardial infarction syndrome or postcardiac injury syndrome)
- Systemic inflammatory disorders, including lupus and rheumatoid arthritis
- Trauma, such as injury to your heart or chest as a result of a motor vehicle or other accident
- Other health disorders, including kidney failure, AIDS, tuberculosis and cancer
Complications of pericarditis
Early diagnosis and treatment of pericarditis usually reduces the risk of the long-term complications. Complications of pericarditis include:
- Pericardial effusion (peri8xcar8xdi8xal ef8xfu8xsi8xon). Pericarditis is usually associated with fluid around the heart, which can lead to more serious complications.
- Chronic constrictive pericarditis. Some people with long-term (chronic) pericarditis develop permanent thickening and scarring of the pericardium, which prevents the heart from filling and emptying properly. This unusual complication often leads to severe swelling of the legs and abdomen and shortness of breath.
- Cardiac tamponade (ca8xrdi8xac tam8xpo8xnad8xe). This life-threatening condition can develop when too much fluid collects in the pericardium. Excess fluid puts pressure on the heart and doesn’t allow it to fill properly. Less blood leaves the heart, causing a dramatic drop in blood pressure. Cardiac tamponade requires emergency treatment.
Diagnosis of pericarditis
The doctor will examine you and ask questions about your symptoms and medical history.
During the exam, the doctor will place a stethoscope on your chest to listen to your heart sounds. Pericarditis causes a specific sound, called a pericardial rub. This noise occurs when the two layers of the sac surrounding your heart (pericardium) rub against each other.
Blood tests are usually done to check for signs of a heart attack, inflammation and infection. Other tests used to diagnose pericarditis include:
- Electrocardiogram (ECG). An electrocardiogram is a quick and painless test that records the electrical signals in your heart. Sticky patches (electrodes) with wires attached connect to a monitor. These electrodes record the electrical signals that make your heart beat. A computer records the information and displays it as waves on a monitor or on paper.
- Chest X-ray. A chest X-ray can show changes in the size and shape of your heart. The images may show an enlarged heart if excess fluid has collected in the pericardium.
- Echocardiogram. Sound waves (ultrasound) create images of the moving heart. Your doctor can use this test to see how well your heart is pumping blood and whether there is fluid buildup in the pericardium or not.
- Cardiac computerized tomography (CT) scan. Cardiac CT scans use X-rays to create images of your heart and chest. This test can be used to look for thickening that may be a sign of constrictive pericarditis. Your doctor may order this test to rule out other causes of sudden chest pain, such as a blood clot in a lung (pulmonary embolus) or a tear in your aorta (aor8xti8xc dis8xsec8xti8xon).
- Cardiac magnetic resonance imaging (MRI). Cardiac MRI uses a magnetic field and radio waves to create cross-sectional images of the heart that can reveal thickening, inflammation or other changes in the pericardium.
Preparing for an appointment with a doctor
You’re likely to start by seeing your primary doctor or an emergency room physician. If you call to schedule an appointment, you may be referred to a doctor trained in heart conditions (cardiologist).
Here’s some information to help you prepare for your appointment with the doctor.
What you can do to prepare
- Write down any symptoms you’re experiencing and for how long. Also note whether 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.
- Take a family member or a friend along with you to the appointment. Someone who accompanies you can help remember what the doctor says.
- Write down the questions you want to ask your doctor.
For pericarditis, some basic questions to ask the doctor include:
- What’s the most likely cause of my symptoms?
- What kinds of tests do I need? Will I need to stay in the hospital for testing?
- What treatment method do you recommend?
- When will my symptoms reduce after treatment?
- What are the possible side effects of the medications you’re prescribing?
- Am I at risk of long-term complications from this disease?
- Will I need follow-up appointments for this disease?
- Do I need to follow any activity or diet restrictions?
In addition to the questions above, don’t hesitate to ask additional questions that occur to you during your appointment.
What the doctor will ask you
Your doctor may ask you the following questions:
- Can you describe your symptoms? Where is the pain? How severe is the pain?
- When did your symptoms start?
- Did your symptoms come on slowly or suddenly?
- 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 you have a first-degree relative — parent, sibling or child — with a history of heart disease?
- Do you smoke tobacco?
Treatment of pericarditis
Treatment for pericarditis depends on the cause and the severity of symptoms. Mild pericarditis may get better without treatment.
Medications used to treat pericarditis
Medications to reduce the inflammation and swelling are often prescribed. These medications include:
- Pain relievers. Pericarditis pain can usually be treated with over-the-counter pain relievers, such as aspirin or ibuprofen (Advil, Motrin IB). Prescription-strength pain relievers also may be used.
- Colchicine (Colcrys, Mitigare). This drug reduces inflammation in the body. It’s used to treat acute pericarditis or if your symptoms tend to come back. You should not take this drug if you have liver or kidney disease. Colchicine can also interfere with other drugs. Your doctor will carefully check your health history before prescribing colchicine.
- Corticosteroids. Corticosteroids are strong medications for treating inflammation. Your doctor may prescribe a corticosteroid such as prednisone if your symptoms don’t get better with other medications, or if symptoms keep returning.
If your pericarditis is caused by a bacterial infection, you’ll be treated with antibiotics and drainage, if necessary.
If pericarditis causes fluid buildup around the heart, you may need drainage or surgery. Treatment methods include:
- Pericardiocentesis (peri8xcar8xdioc8xent8xes8xis). 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 numbing medication (local anesthetic) before the procedure. The doctor uses ultrasound and echocardiogram images to guide the needle and tube to the correct location in the body. This drain stays in place for several days while you are in the hospital.
- Pericardiectomy (peri8xcar8xdie8xctom8xy). This surgery removes the entire pericardium. This surgery may be done if the sac surrounding the heart has become permanently rigid due to constrictive pericarditis.
Lifestyle and home remedies
For mild pericarditis, rest and over-the-counter pain medications — taken under your doctor’s direction — may be all that’s needed.
While you recover, avoid strenuous physical activity and competitive sports. Such activity can trigger pericarditis symptoms. Ask your doctor how long you need to rest.