Pericarditis is a condition that affects the thin, two-layered sac that surrounds and protects the heart. The pericardium usually contains a small amount of fluid that lubricates the heart and prevents friction. Acute pericarditis can last less than three weeks, chronic pericarditis can last more than three months, and recurrent pericarditis can occur at any time. Additionally, pericarditis can lead to complications such as fluid buildup around the heart (pericardial effusion) or scarring and thickening of the pericardium (constrictive pericarditis).
The exact cause of pericarditis is often unknown, but it may be related to various factors such as:
Viral, bacterial, fungal, or parasitic infections
Heart attack or heart surgery
Injury to the chest or radiation therapy
Autoimmune diseases such as lupus or rheumatoid arthritis
Kidney failure or cancer
Certain medications such as blood thinners or anti-seizure drugs
The most common symptom of pericarditis is chest pain that:
Feels sharp, stabbing, or piercing
Occurs behind the breastbone or on the left side of the chest
Worsens with breathing, coughing, lying down, or swallowing
Improves with sitting up or leaning forward
Other symptoms of pericarditis may include:
Fever
Fatigue
Cough
Shortness of breath
Palpitations
Swelling of the abdomen or legs
During a physical examination and interview with your physician, your doctor will determine if you have pericarditis. With a stethoscope, your doctor will listen to your heart and lungs for signs of inflammation, such as a pericardial rub (a grating sound produced by the pericardial layers rubbing against each other). To confirm the diagnosis and rule out other conditions, your doctor may order some tests.
Electrocardiogram (ECG): A test that records the electrical activity of your heart and shows changes that indicate pericarditis.
Chest X-ray: A test that uses radiation to create images of your chest and shows the size and shape of your heart and lungs.
Echocardiogram: A test that uses sound waves to create images of your heart and shows how well it pumps blood and whether there is fluid around it.
Blood tests: Tests that measure the levels of certain substances in your blood such as inflammation markers, infection markers, or cardiac enzymes.
Pericardiocentesis: A procedure that involves inserting a needle or a catheter into the pericardial space and draining excess fluid for analysis.
Treatment of pericarditis depends on its cause, severity, and duration. The main goals are to relieve pain, reduce inflammation, prevent complications, and treat the underlying cause. Treatment options include:
Ibuprofen and naproxen are anti-inflammatory drugs that your doctor may prescribe to relieve pain and inflammation. Additionally, you may need colchicine (a drug that prevents recurrence), corticosteroids (drugs that suppress the immune system), antibiotics (drugs that treat bacterial infections), or antivirals (drugs that treat viral infections).
The procedure called pericardiocentesis may be necessary to drain a large amount of fluid around your heart if it causes symptoms or complications. You may need a surgery called a pericardiectomy to remove part or all of the pericardium if you have constrictive pericarditis that interferes with your heart function.
There is no specific way to prevent pericarditis, but you can reduce your risk by:
Taking care of your health and avoiding infections
Following your doctor’s instructions after a heart attack or heart surgery
Protecting your chest from injuries or radiation exposure
Managing your chronic conditions such as kidney failure or cancer
Taking your medications as prescribed and reporting any side effects
The majority of cases of pericarditis resolve on their own within a few weeks. However, some cases can become chronic or recurrent and require long-term treatment. A pericarditis can also lead to life-threatening conditions such as cardiac tamponade (when fluid compresses the heart) or constrictive pericarditis (which restricts the heart's movement). When you have symptoms of pericarditis, you should seek medical attention and follow your doctor's advice. Most people with pericarditis can recover and lead normal lives with proper treatment.
