Pericarditis is a swelling and irritation of the pericardium, the thin sac-like membrane that surrounds your heart. Pericarditis often causes chest pain and sometimes other symptoms. Pericarditis is usually sudden and short-lived (acute).
When symptoms develop more gradually or persist, the pericarditis is considered chronic. The sharp chest pain associated with pericarditis occurs when the inflamed or irritated two layers of the pericardium rub against each other.
Mild cases may improve on their own. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help to reduce the risk of long-term complications.
Acute pericarditis usually lasts less than a few weeks. Chronic pericarditis usually lasts six months or longer.
If you have acute pericarditis, the most common symptom is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. However, some people with acute pericarditis describe their chest pain as dull, achy or pressure-like instead, and of varying intensity.
The pain of acute pericarditis may travel into your left shoulder and neck. It often intensifies when you lie down or inhale deeply. Coughing, taking a deep breath or swallowing food also may make the pain worse. Sitting up and leaning forward can often ease the pain. At times, it may be difficult to distinguish pericardial pain from the pain that occurs with a heart attack.
Chronic pericarditis is usually associated with chronic inflammation and may result in fluid around the heart (pericardial effusion). The most common symptom of chronic pericarditis is chest pain.
Depending on the type, signs and symptoms of pericarditis may include some or all of the following:
When to see a doctor
Many of the symptoms of pericarditis are similar to those of other heart and lung conditions. 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 be a heart attack or a blood clot of the lungs (pulmonary embolus).
Under normal circumstances, the two-layered pericardial sac that surrounds your heart contains a small amount of lubricating fluid. In pericarditis, the sac becomes inflamed and the resulting friction from the inflamed sac leads to chest pain.
In some cases the amount of fluid contained in the pericardial sac may increase, causing a pericardial effusion.
The cause of pericarditis is often hard to determine. In most cases doctors are either unable to determine a cause (idiopathic) or suspect a viral infection.
Pericarditis can also develop shortly after a major heart attack, due to the irritation of the underlying damaged heart muscle. In addition, a delayed form of pericarditis may occur weeks after a heart attack or heart surgery because of antibody formation. This delayed pericarditis is known as Dressler's syndrome. Many experts believe Dressler's syndrome is due to an autoimmune response, a mistaken inflammatory response by the body to its own tissues — in this case, the heart and pericardium.
Other causes of pericarditis include:
Complications may include:
Early diagnosis and treatment of pericarditis usually reduces the risk of the long-term complications.
Preparing for your appointment
You're likely to start by first seeing your family doctor or an emergency room physician. In some cases when you call to set up an appointment, you may be referred to a doctor who specializes in the diagnosis and treatment of heart conditions (cardiologist).
Here's some information to help you prepare for your appointment.
What you can do
For pericarditis, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Tests and diagnosis
Your doctor likely will start by taking your medical history and asking questions about your chest pain and other symptoms. As part of your initial evaluation, your doctor will also perform a physical exam and check your heart sounds.
While listening to your heart, your doctor will place a stethoscope on your chest to check for the sounds characteristic of pericarditis, which are made when the pericardial layers rub against each other. This characteristic noise is called a pericardial rub.
Your doctor may have you undergo tests that can help determine whether you've had a heart attack, whether fluid has collected in the pericardial sac, or whether there are signs of inflammation. Your doctor may use blood tests to determine if a bacterial or other type of infection is present. You may also undergo one or more of the following diagnostic procedures:
Treatments and drugs
Your treatment choice for pericarditis depends on the cause as well as the severity. Mild cases of pericarditis may get better on their own without treatment.
Acute episodes of pericarditis typically last from one to three weeks, but future episodes can occur. Some people with pericarditis have a recurrence within months of the original episode.
When a bacterial infection is the underlying cause of pericarditis, you'll be treated with antibiotics and drainage if necessary.
Hospitalization and procedures
Last Updated: 2011-04-29
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