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Overview
What is pericarditis?
Pericarditis is an inflammation of the pericardium, the protective sac surrounding the heart. This sac consists of three thin layers with a small amount of fluid between them to prevent friction. The pericardium keeps the heart in place within the chest and protects it from infections.
Pericarditis can be classified into acute, subacute, chronic or recurrent types depending on how long the condition has persisted. Some individuals with pericarditis may also develop a pericardial effusion, where excess fluid builds up around the heart. If the fluid accumulates excessively, it can lead to cardiac tamponade, a life-threatening condition that prevents the heart from pumping normally.
What are pericarditis symptoms?
Symptoms of pericarditis can appear suddenly or gradually and may range from severe to minimal. Common symptoms include:
- Chest pain that worsens with breathing and improves by sitting up or leaning forward
- Irregular or fast heartbeat
- Shortness of breath
- Pain in the neck or shoulders
- Fever
These symptoms can resemble a heart attack or other serious health conditions, so immediate medical attention is recommended if symptoms worsen or include severe chest pain or shortness of breath.
What causes pericarditis?
Pericarditis can be caused by various factors, including:
- Infections: Viruses are the most common cause, but bacteria, fungi and parasites can also lead to pericarditis.
- Autoimmune diseases: Conditions like rheumatoid arthritis and lupus can cause pericarditis.
- Medications: Certain heart medications, antibiotics, antidepressants and drugs used for cancer treatment can lead to pericarditis.
- Other factors: Age, gender, family history, genetics, alcohol use, recreational drugs and specific medical conditions like diabetes or cancer can increase the risk of pericarditis.
What can make you at risk of pericarditis?
Age, sex and family history
- Age: Different age groups are at risk for different types of heart inflammation.
- Although they can affect all ages, myocarditis and pericarditis occur more often in young adults. Pericarditis also affects middle-aged adults.
- Older adults are more at risk for cancers and other major medical problems that may lead to pericardial disease. Some of these are outlined below.
- Sex: Heart inflammation from endocarditis, myocarditis and pericarditis is more common in men than in women. This is true except when the inflammation is caused by autoimmune diseases, such as lupus and rheumatoid arthritis, which are more common in women. Endocarditis and pericarditis occur twice as often in men as in women.
- Family history and genetics: Genetics play a role in the risk for all three types of heart inflammation.
- Your genes may play a role in how your body responds to infection and inflammation and whether you contract myocarditis or pericarditis.
- People who have structural or congenital heart defects, such as problems with the heart valves, may be at higher risk for infections that can cause endocarditis.
- Certain inherited conditions can affect your risk of heart inflammation. For example, you may be at higher risk for myocarditis and pericarditis if you have familial Mediterranean fever or tumor necrosis factor receptor-associated periodic syndrome (TRAPS) external link. These rare conditions affect how the body controls inflammation.
Lifestyle choices
Your risk may be higher if you:
- Drink too much alcohol, which could also lower heart function and cause heart failure
- Use cocaine, amphetamines or recreational drugs injected intravenously (into the veins)
Medical conditions
Medical conditions that can raise your risk include:
- Diabetes, which can make you more likely to contract infections
- Cancers either directly or through medications used to treat the cancer.
- Eating disorders, such as anorexia
- HIV/AIDS, which may lead to myocarditis from infections, poor nutrition and certain treatments
- Skin disorders, such as burns or chronic infections
- Poor dental health
Procedures to treat other medical conditions also carry a risk of infection, which can lead to heart inflammation. These include implanting a pacemaker or defibrillator in the heart.
How doctors diagnose pericarditis
Diagnosing pericarditis involves a physical exam and various tests, such as:
- EKG/ECG: To measure electrical signals and heart rhythm.
- Chest X-ray: To detect fluid buildup, enlarged heart or other lung problems.
- Echocardiography: Uses sound waves to visualize the heart and check for inflammation.
- Blood tests: To check for inflammation, infection or heart muscle injury markers.
- Advanced imaging: Cardiac CT or MRI can provide detailed images of the heart.
- Pericardiocentesis: A procedure to remove excess fluid if cardiac tamponade is suspected.
How you can treat pericarditis
Treatment varies depending on the cause and severity of the condition. The primary goals of most treatments are to reduce pain, decrease inflammation of the pericardium and address pericardial effusion if necessary.
Supportive measures may include:
- Bedrest
- IV or oral fluids to maintain blood pressure and make sure adequate blood flows to other organs
- Beta-blockers to lower blood pressure, reduce heart rate and decrease overall stress on the heart
- Diuretics to remove excess fluid that could be overburdening the heart
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Medication
- The first line of treatment for pain relief and reducing inflammation usually includes colchicine, aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Common side effects are mainly gastrointestinal such as abdominal pain, nausea, vomiting and diarrhea.
- Corticosteroids like prednisone lower the body’s immune system. In cases of pericarditis, corticosteroids are prescribed only for patients who do not respond or cannot take NSAIDs. Potential side effects include weight gain and increased risk of infection.
- If a bacterial infection is the underlying cause, antibiotics can be used for treatment.
- Intravenous immunoglobulin (IVIG) may be administered to help control the body’s immune and inflammatory response, especially in cases related to autoimmune disorders like lupus.
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Procedures or surgery
If too much fluid accumulates in the pericardial sac, the pressure buildup can prevent the heart from expanding fully, making it difficult to pump enough blood to the body. This life-threatening condition is called tamponade. In these cases, a procedure called pericardiocentesis may be performed in the cardiac catheterization laboratory to remove excess fluid. During this procedure, a thin needle is inserted directly into the pericardial sac to drain the fluid, followed by the placement of catheters to allow continued drainage. While complications are rare, the risks include bleeding, infection or damage to the heart.
If pericardiocentesis is not a viable option, surgery to remove part or all of the pericardium and the fluid may be considered. A pericardial window procedure involves removing a small portion of the pericardium to prevent fluid from reaccumulating in the sac. Pericardiectomy, a different surgery, involves removing most of the pericardium. This option is typically recommended only when medications or other treatments have been ineffective. It can be a successful option for people with recurrent pericarditis or those with end-stage constrictive pericarditis, a condition in which the pericardium becomes scarred and thickened.
How to prevent pericarditis
You may not be able to prevent heart inflammation. Many causes of myocarditis and pericarditis are hard or impossible to avoid or prevent. Managing some risk factors for diseases, such as HIV and avoiding substances such as amphetamines and cocaine, may help prevent these disorders.
Pericarditis treatment near you
Cardiology services at Ballad Health
Our extensive network of highly trained cardiologists, surgeons and advanced practice providers are here to support you and help you navigate a heart-related diagnosis.
Learn more about heart and vascular services at Ballad Health.
CVA Heart Institute Learning Center
We understand that receiving a pericarditis diagnosis can be overwhelming. Our goal is to alleviate your fears and help you to understand your condition.
We have an informational video library, education tools and heart-related FAQs so that you have the resources you need.
Heart care patient stories
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Read our patient stories
Our patients inspire us every day, and we’re honored when they trust us with their care. They tell their stories best, so we’ve gathered a few here to share with you.
Many of these patients received life-saving care for heart conditions when they weren’t experiencing any symptoms. These experiences have changed they way they look at their individual care and helped them see the importance of regular preventive screenings.