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Pericarditis

Pericarditis is inflammation of the pericardium, the sac that surrounds and protects your heart. Your pericardium helps your heart work properly and holds it in place within your chest. It has two layers, with a small amount of fluid between. This fluid keeps the layers from rubbing together as your heart beats.

The main symptom of pericarditis is chest pain, often relieved by sitting up and leaning forward.

In many cases it’s not clear what has caused pericarditis. It’s thought that viral infections are often responsible. However, there are many other possible causes, including a heart attack. People of all ages can get pericarditis but it’s more common in adults.

Man having heart checked

Details

  • The different types The different types of pericarditis

    Doctors usually divide pericarditis into three main types. These are:

    • acute pericarditis – this means it comes on suddenly and usually gets better within days or weeks
    • recurrent pericarditis – this is when acute pericarditis goes away but then comes back on one or more occasions
    • chronic pericarditis – when the condition lasts for a long time (over three months)

    Pericarditis can also be divided into types according to what causes it. See our section on causes below.

  • Symptoms Symptoms of pericarditis

    The main symptom of pericarditis is pain in your chest. The pain is usually constant, and is often sharp. Or you may feel a dull, aching pain. You may find this gets better if you sit and lean forwards. The pain may spread to your neck and shoulders (especially the left shoulder). It tends to get worse if you lie down, when you breathe in, swallow or cough.

    For some people, symptoms may include:

    • a fever
    • a cough
    • breathlessness
    • feeling weak

    The symptoms of pericarditis are similar to those of a heart attack – so if you have any sudden chest pain, seek urgent medical attention. You may need to have some tests to find out which condition you have.

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  • Diagnosis Diagnosis of pericarditis

    If you have symptoms of pericarditis you may be seen by a cardiologist. This is a doctor who specialises in identifying and treating conditions of the heart and blood vessels. They’ll ask about your symptoms and examine you. Your doctor may also ask about your medical history and if you’ve recently had symptoms of an infection, such as a cold or flu.

    Your doctor will listen to your heart with a stethoscope. They may be able to hear a ‘rubbing’ sound called pericardial rub, which is a sign of pericarditis.

    When you first have symptoms, your doctor may recommend some simple tests. These include the following.

    • Blood tests. These can be used to check for signs of inflammation. Blood tests can also help to show whether you’ve had, or are having, a heart attack.
    • 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.
    • A chest X-ray. If inflammation has caused a large amount of fluid to build up within your pericardium, the X-ray may show that your heart is enlarged.

    Your doctor may recommend further tests if your symptoms don’t go away or if they think you’re at risk of getting complications. (See our section on complications of pericarditis below for more explanation of what these problems might be). Further tests may include the following.

    • An echocardiogram (ultrasound of your heart). This will help your doctor to see if there is any excess fluid (an effusion) between the two layers of your pericardium. It also lets them measure blood flow through your heart. This helps to check whether your pericardium has become thickened and hardened (constrictive pericarditis).
    • A CT scan or MRI scan. If your pericardium is thickened it will show up in these scans.
    • Examination of pericardial fluid. Your doctor may drain fluid from your pericardium and test this for signs of infection.
  • Treatment Treatment of pericarditis

    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 (TB), your doctor will prescribe a course of antibiotics.

    Your doctor may advise you to take over-the-counter painkillers or prescribe non-steroidal anti-inflammatory drugs (NSAIDs) for the pain. They’ll also probably recommend you take 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 offer you a medicine called colchicine to help with the pain.

    Your doctor may also prescribe colchicine if you have recurrent 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.

    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 read the patient information leaflet that comes with your medicine carefully. If you have any questions about your medicines, ask your pharmacist.

    Your doctor will advise you to rest and not do any strenuous activity for a few weeks. This will help reduce your symptoms and reduce the risk of abnormal heart rhythms.

    Talk to your doctor about how much time you’ll need off work. This will depend on how severe the pericarditis is and what sort of work you do. If the symptoms have largely settled and you feel well, it would be OK to go back to work that isn’t physically demanding within a few days. However, if you do hard physical work two weeks off would be a minimum. After that it depends on when the symptoms have settled and when you feel well.

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  • Causes Causes of pericarditis

    Pericarditis happens when there is inflammation of your pericardium, the double-layered sac which surrounds your heart. The most common cause is a viral infection but in many people the cause of this inflammation is unknown. Viral infections causing pericarditis usually don’t last long – settling within a week or two.

    Other, less common causes of pericarditis include:

  • Complications Complications of pericarditis

    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

    Pericardial effusion is when the inflammation causes fluid to build 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

    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 (TB). It may also happen after heart surgery, after radiotherapy to your chest or if you have rheumatoid arthritis. 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.

  • FAQ: Pericarditis after heart attack How long after a heart attack can pericarditis start?

    It used to be more common for people to get pericarditis after a heart attack. Now, with modern medicines fewer than one person in ten who has a heart attack gets pericarditis.

    If your pericarditis was caused by a heart attack, it can begin as soon as two days afterwards. In rare cases it may take longer than this and might not begin until several weeks after you have a heart attack.

    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.

  • FAQ: Pericarditis and myocarditis How do pericarditis and myocarditis compare?

    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 inflammation 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 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. This is to help prevent the condition coming back and to prevent any abnormal heart rhythms. Occasionally myocarditis can lead to a long term problem with weakness of the heart (cardiomyopathy).

  • Resources Resources

    Further information

    Sources

    • Pericarditis. BMJ Best practice. bestpractice.bmj.com, last updated 19 December 2016
    • Acute pericarditis. Medscape. emedicine.medscape.com, updated 25 January 2017
    • Constrictive pericarditis. Medscape. emedicine.medscape.com, updated 23 December 2014
    • Myocarditis. Medscape. emedicine.medscape.com, updated 19 December 2016
    • Acute pericarditis. PatientPlus. patient.info/patientplus, last checked 2 November 2016
    • Chronic pericarditis. PatientPlus. patient.info/patientplus, last checked 2 November 2016
    • Myocarditis. PatientPlus. patient.info/patientplus, last checked 24 January 2017
    • Alabed S, Cabello JB, Irving GJ, et al. Colchicine for pericarditis. Cochrane Database of Systematic Reviews 2014, Issue 8. doi: 10.1002/14651858.CD010652.pub2
    • Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC). Eur Heart J 2015; 36(42): 2921–64. doi:10.1093/eurheartj/ehv318
    • What is pericarditis? American Heart Association. www.heart.org, last reviewed March 2016
    • Personal communication, Dr Tim Cripps, Consultant Cardiologist
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  • Author information Author information

    Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, March 2017
    Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
    Next review due March 2020

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