The main symptom of pericarditis is a sharp, constant pain in your chest. You may find this gets better if you sit and lean forwards. The pain may spread to your left shoulder and arm. It tends to get worse if you lie down, when you breathe in, swallow or cough. Other symptoms include:
- a fever
- a cough
- feeling weak
The symptoms of pericarditis are similar to those of a heart attack. You may need to have some tests to determine which condition you have. If you have any sudden chest pain, seek urgent medical attention.
You may see a cardiologist in hospital – a doctor who specialises in identifying and treating conditions of the heart and blood vessels. They will ask about your symptoms and examine you. Your doctor may also ask about your medical history and if you have recently had symptoms of an infection, such as a cold or flu.
Your doctor will listen to your heart with a stethoscope. He or she may be able to hear a ‘rubbing’ sound called pericardial rub, which is a sign of pericarditis.
Other tests you may have include the following.
- Blood tests. These can be used to check for signs of inflammation.
- An electrocardiogram (ECG). This test measures the electrical activity of your heart to see how well it’s working. There are certain changes that your doctor can look for that might help in diagnosing pericarditis.
- An echocardiogram will help your doctor to see if there is any fluid in between the two layers of your pericardium. An echocardiogram is an ultrasound scan of your heart. See our FAQs for more information.
- A chest X-ray. If there is a large amount of fluid within your pericardium, the X-ray may show that your heart is enlarged.
- A CT scan or MRI scan. If your pericardium is thickened because of a condition called constrictive pericarditis, it will show up in these scans. Constrictive pericarditis can be caused by a number of things.
- Examination of pericardial fluid. Your doctor may drain fluid from your pericardium and test this for signs of infection or cancer cells.
Most people with pericarditis get better within days or weeks without any treatment. However, you may need treatment for the symptoms or to prevent complications.
If possible, any underlying cause of pericarditis should be treated. For example, if your pericarditis was caused by a bacterial infection such as tuberculosis, your doctor will you prescribe a course of antibiotics.
Your doctor may advise you to take over-the-counter painkillers or prescribe you non-steroidal anti-inflammatory drugs (NSAIDs) for the pain. They will also probably prescribe you a medicine called a proton pump inhibitor. This is because NSAIDs can cause side-effects that affect your stomach and proton pump inhibitors can reduce these. Your doctor may also prescribe you a medicine called colchicine to help with the pain.
Your doctor may also prescribe you colchicine if you have reoccurring pericarditis (where your condition comes back after a period of time). This may keep your symptoms away for longer. Attacks of pericarditis may also be shorter with less severe symptoms.
If your doctor prescribes you colchicine in the UK, it will be for off-label use. This means the medicine is being used to treat a condition that it hasn’t been licensed for. It isn’t listed in the patient information leaflet that comes with the medicine. A doctor can legally prescribe outside the licence if they believe the medicine will be effective for you.
Some types of pericarditis can be treated with corticosteroid medicines but these don’t work for everybody. Ask your doctor if they are an option for you.
Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
Your doctor will advise you to rest and not do any strenuous activity for a few weeks to help reduce your symptoms.
Pericarditis happens when there is inflammation of your pericardium. This may lead to a build-up of fluid and a thickening of your pericardium. In many people, it’s not known what causes it. But there are some things that are known to cause pericarditis, which include:
- a heart attack
- viral or bacterial infections, particularly tuberculosis bacteria (TB)
- inflammatory conditions, such as rheumatoid arthritis and systemic lupus erythematosus
- problems with your metabolism, such as kidney failure and an underactive thyroid (hypothyroidism)
- certain types of cancer, especially breast cancer and lung cancer
- reactions to certain medicines
- radiotherapy on your chest
- an injury to your chest from an accident or surgery
Pericarditis can lead to two complications called pericardial effusion and constrictive pericarditis. You’ll need further treatment if you develop either of these.
Pericardial effusion is when fluid builds up between the two layers of your pericardium. If too much fluid builds up, it can prevent your heart from filling properly because of the increased pressure. This is known as cardiac tamponade.
If you have pericardial effusion, you may need to have a procedure to drain the excess fluid and allow your heart to work well again. This is called pericardiocentesis or a pericardial tap.
Constrictive pericarditis is a thickening and hardening of your pericardium. This may happen as a result of a long-term infection of your pericardium, sometimes because of tuberculosis. However, there may be no clear cause. The thickened pericardium stops your heart from filling properly between heartbeats. You may need to have an operation to remove part or all of your pericardium to help your heart to function as it should.
What does an echocardiogram involve?
An echocardiogram is an ultrasound scan of your heart. Ultrasound uses sound waves to produce an image of your heart on a monitor. This can help your cardiologist (a doctor who specialises in identifying and treating conditions of the heart and blood vessels) make a diagnosis of pericarditis.
Having an echocardiogram isn’t painful and it usually takes between 30 and 40 minutes.
You’ll be asked to remove your clothing from the waist up and to put on a gown that will be open at the front. You will lie on your left side on an examination bed. A sonographer (a person specially trained to do ultrasounds) will dim the lights to make the images easier to see.
The sonographer will put some gel on your chest so that the ultrasound waves can be picked up better by the machine. They will place the ultrasound probe (similar to a large, smooth pen) onto your chest and move it around. This will get images of your heart from different angles.
You’ll probably have an electrocardiogram (ECG) done at the same time. This will measure the electrical activity of your heart to see how well it’s working. You will have some electrode patches stuck to your chest for this test.
If you have any questions about having an echocardiogram, ask your doctor.
How long after a heart attack does it usually take for pericarditis to develop?
If your pericarditis was caused by a heart attack, it can begin as soon as two days afterwards. It may take longer than this and might not begin until months after you have a heart attack. However, it’s much less likely that you’ll develop pericarditis after a heart attack than it used to be. This is because there are more effective medicines to treat a heart attack.
The treatment doctors give after a heart attack has reduced the number of people going on to develop pericarditis to fewer than one in 10. If you do get pericarditis soon after a heart attack, you may not need treatment for it. This is because the condition may go away on its own and rarely leads to complications.
Another type of pericarditis that used to be more common is Dressler syndrome. This is pericarditis that begins between two and 10 weeks after a heart attack. It’s caused by your immune system reacting to the damaged heart tissue. However, medicines given after a heart attack have reduced this happening and Dressler syndrome is now rare.
What is the difference between pericarditis and myocarditis?
Pericarditis is inflammation of the sac surrounding your heart (the pericardium) and myocarditis is inflammation of the heart muscle itself. Each condition has slightly different symptoms. Often, pericarditis and myocarditis occur together because the inflammatory process also involves the outer layer of heart muscle below the pericardium.
Pericarditis is commonly caused by a virus that infects your pericardium surrounding your heart. However, often no cause can be found. One symptom of pericarditis is sharp pain in your chest, which gets worse if you lie down but improves if you sit leaning forwards. Other symptoms may include a fever or breathlessness. Your cardiologist may give you non-steroidal anti-inflammatory drugs (NSAIDs) to take to ease the pain. Sometimes, your doctor may give you a medicine called colchicine, or corticosteroids.
Myocarditis is also often caused by a virus or bacterium that has infected the muscle of your heart. Symptoms include chest pain, breathlessness and palpitations (an unpleasant awareness of your heartbeat, often described as a thumping in your chest). Unlike pericarditis, you might not need any medicine as the condition often goes away on its own. However, your doctor may advise you to take a break from strenuous exercise for several months after you recover to help prevent the condition coming back.
- British Heart Foundation
0300 330 3311
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- Imazio M, Belli R, Brucato A, et al. Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial. Lancet 2014; 383(9936):2232–37. doi: 10.1016/S0140-6736(13)62709-9
- Maisch B, Seferović PM, Ristić AD, et al. Guidelines on the diagnosis and management of pericardial diseases. Eur Heart J 2004; 25(7):587-610. doi:10.1016/j.ehj.2004.02.002.
- Imazio M, Brucato A, Forno D. Efficacy and safety of colchicine for pericarditis prevention. Systematic review and meta-analysis. Heart 2012; 98(14):1078–82. doi:10.1136/heartjnl-2011-301306
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- British Heart Foundation
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