Pericarditis
Pericarditis is an inflammation of the connective tissue membrane surrounding the heart – the pericardium. It can cause chest pain, shortness of breath, and a general feeling of illness. The condition is usually benign and resolves on its own, but it requires the correct diagnosis and sometimes treatment.
The inflammation may occur on its own or together with another heart condition. Its most important differential diagnosis is myocardial infarction, as the symptoms can be similar.
What causes pericarditis?
The most common cause of pericarditis is a viral infection, but other possible causes include:
- Bacterial infections (rare)
- Autoimmune diseases (e.g., rheumatoid arthritis, lupus)
- Post–myocardial infarction syndrome (Dressler’s syndrome)
- Kidney failure
- Radiation therapy or cancer
- Heart surgery or catheter-based procedures
Symptoms of pericarditis
The most typical symptom is sharp chest pain that:
- May radiate to the shoulder or neck
- Worsens when lying down and improves when sitting forward
- Is not related to exertion like the pain of a heart attack
Other possible symptoms include:
- Shortness of breath (especially when lying down)
- Fever or low-grade fever
- Cough or fatigue
- Palpitations or irregular heartbeat
If a large amount of fluid accumulates in the pericardial sac, circulatory disturbances and low blood pressure may occur.
How is pericarditis diagnosed?
Diagnosis is based on symptoms and cardiac examinations. To support the diagnosis, the following are used:
- ECG – often shows characteristic changes
- Blood tests – inflammatory markers (CRP), cardiac enzymes (troponin)
- Echocardiography (ECHO) – shows possible fluid in the pericardium
- X‑ray or cardiac MRI when needed
Treatment and recovery
Most cases of pericarditis are mild and improve with rest. Treatment includes:
- Anti-inflammatory pain medications (e.g., ibuprofen, aspirin)– reduce pain and speed recovery
- Colchicine – prevents recurrence and may shorten the illness
- Corticosteroids – rarely used, only if other treatments are ineffective or if the inflammation is autoimmune in origin
In severe cases where a large amount of fluid accumulates in the pericardium, drainage of the fluid (pericardiocentesis) is required.
Prognosis and follow-up
Most people recover well within a few weeks. About one in four may develop recurrent pericarditis, which requires longer medication and follow-up. In rare cases, the inflammation becomes chronic or the pericardium becomes scarred, which can limit heart function (so-called constrictive pericarditis).
A follow-up visit is often recommended a few weeks after initial treatment.
When to see a doctor
Contact a doctor if:
- You have new or unusual chest pain that worsens when lying down
- Your general condition deteriorates rapidly or you experience shortness of breath
- You have had pericarditis before and the symptoms return
Pericarditis can feel frightening, but in most cases it is treatable and heals well. At our Heart Center, we perform the necessary examinations quickly and safely.