Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
Next review due September 2021

Pericarditis is inflammation of the pericardium, the sac (bag) that surrounds and protects your heart. Its main symptom is chest pain, which often gets better if you sit up and lean forwards.

Man having heart checked

What is pericarditis?

Your pericardium helps your heart to work properly. It also protects your heart and holds it in place inside your chest. It has two layers, with a small amount of fluid between them. This fluid keeps the layers from rubbing together when your heart beats.

If your pericardium gets inflamed, water, blood and fluid can leak through it, causing pain. This is called pericarditis. People of all ages can get pericarditis but it’s more common in adults. Viral infections are one of the most common triggers.

Types of pericarditis

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

  • acute pericarditis – when you get pericarditis for the first time and it lasts for up to six weeks
  • recurrent pericarditis – when your acute pericarditis goes away but comes back after four to six weeks
  • chronic pericarditis – when your pericarditis lasts for a long time (over three months)

Symptoms of pericarditis

If you have pericarditis, you’ll notice pain in your chest. This pain is usually constant and may be sharp, stabbing or aching. You may find this gets better if you sit down and lean forwards. The pain may spread to your neck and shoulders (especially your left shoulder). It tends to get worse if you lie down, breathe in, swallow or cough.

You may also have:

  • a slight fever (raised temperature)
  • a cough
  • difficulty breathing
  • faster-than-usual breathing
  • difficulty swallowing

Pericarditis or heart attack?

The symptoms of pericarditis are similar to those of a heart attack – so if you have any sudden chest pain, get urgent medical advice. You may need to have some tests to check what’s causing the pain. The pain caused by pericarditis is often affected by your posture. It may feel different as you change your position. The pain associated with a heart attack is less likely to be affected by posture. However, heart attacks don’t always happen in a typical way, so it’s always best to seek medical advice as soon as possible.

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 scratching or grating sound called pericardial rub. This is a sign of pericarditis.

If you’ve never had pericarditis before, your doctor may recommend the following tests.

  • Blood tests. These can check for signs of inflammation. These can also help to show whether you’ve had, or are having, a heart attack.
  • An electrocardiogram (ECG). This measures the electrical activity of your heart to see how well it’s working. Your doctor can look for specific changes that can be caused by pericarditis, which may help with the diagnosis.
  • A chest X-ray. If there’s a lot of fluid in your pericardium, the X-ray may show your heart is bigger than it should be.

Your doctor may recommend more tests if your symptoms don’t go away or if they think you’re at risk of complications.

  • An echocardiogram (ultrasound of your heart). Your doctor will be able to see if there’s too much fluid (an effusion) between the two layers of your pericardium. They’ll also be able to measure the blood flow through your heart. This helps to check whether your pericardium has thickened and hardened (called constrictive pericarditis).
  • A CT scan or MRI scan. These can show whether or not your pericardium has thickened.
  • Examination of your pericardial fluid. Your doctor may drain fluid from your pericardium and test this for signs of an infection.

Treatment of pericarditis

Most people with pericarditis get better in six weeks. The treatment will depend on what’s causing your pericarditis and how bad your symptoms are.

If you have a high temperature or a lot of fluid around your heart, you may need to go into hospital. But if your symptoms aren’t very bad, you may be given treatment to take at home with regular check-ups.

Medicines for pericarditis

Your doctor may advise you to take over-the-counter painkillers or prescribe non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. These medicines can lower your fever, ease your chest pain and reduce any inflammation. Your doctor will also probably recommend that you take a medicine called a proton pump inhibitor to protect your stomach lining. This is because NSAIDs may irritate your stomach, causing an ulcer.

Your doctor may offer you a medicine called colchicine to help with the pain. Your doctor may also prescribe colchicine if you have recurrent pericarditis (when your condition comes back after a while). You may need to take the colchicine for several months. This may keep your symptoms away for longer.

Some types of pericarditis can be treated with corticosteroid medicines, but these don’t work for everyone. Ask your doctor if they’re an option for you.

If something specific is causing your pericarditis, your doctor will treat that too. So, if your pericarditis was caused by a bacterial infection, your doctor will prescribe a course of antibiotics.

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

Exercise and work

Your doctor will advise you to rest. You shouldn’t do any strenuous activity for a few weeks, until your pericarditis has gone and your heart is back to normal. This will help to reduce your risk of low blood pressure and abnormal heart rhythms. If you do a lot of sport, you may need to limit exercise for at least three months.

Talk to your doctor about how long you’ll need to take off work. This will depend on how bad your pericarditis is and the type of work you do. If your symptoms have largely settled and you feel well, you may be able to go back to work that isn’t physically demanding after a few days. But if your job involves physical work, you may need to take off at least two weeks. This will depend on when your symptoms have settled and when you feel well enough.

Causes of pericarditis

You get pericarditis if your pericardium, the double-layered sac (bag) around your heart, becomes inflamed. This is most likely to be caused by a viral infection, but there are lots of other causes too.

Other causes include:

  • autoimmune conditions, such as rheumatoid arthritis and systemic lupus erythematosus. This is when your immune system attacks your healthy tissues
  • a heart attack
  • bacterial infections, especially tuberculosis bacteria (TB)
  • 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

Sometimes, though, doctors can’t work out what’s causing pericarditis.

Complications of pericarditis

Pericarditis usually clears up without any complications and doesn’t come back again. But sometimes, when the condition is very bad, it can lead to pericardial effusion or constrictive pericarditis. These two complications can occur together. The symptoms may be similar to pericarditis, and can include difficulty breathing and swelling around your tummy or legs.

Pericardial effusion

Pericardial effusion is when inflammation causes fluid to build up between the two layers of your pericardium. If too much fluid builds up, this can stop your heart from filling properly because of the increased pressure. This is called cardiac tamponade.

If you have pericardial effusion, you may need to have a procedure to drain the excess fluid so your heart can work properly again. This is called pericardiocentesis or a pericardial tap.

Constrictive pericarditis

Constrictive pericarditis is a thickening and hardening of your pericardium. This may happen after a long-term infection of your pericardium, sometimes because of tuberculosis (TB). It may also happen after heart surgery or radiotherapy to your chest. But sometimes there’s 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 work properly again.

Frequently asked questions

  • It used to be more common for people to get pericarditis after a heart attack. But now, with modern medicines, fewer than one person in 10 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. But very occasionally, it may not begin for several weeks.

    If you do get pericarditis soon after a heart attack, you may not need any treatment for it. This is because the condition may go away on its own and rarely leads to complications.

  • Pericarditis is inflammation of the sac around your heart (the pericardium). Myocarditis is inflammation of the heart muscle itself. Each condition causes slightly different symptoms, but you can have both of them at the same time.

    Both pericarditis and myocarditis may be caused by a virus that infects your heart – either the pericardium or the muscle. But sometimes your doctor can’t find the exact cause. Myocarditis can be mistaken for a heart attack, and vice versa, especially in people with risk factors for both (such as smoking).

    If you have pericarditis, you’re likely to have a sharp pain in your chest. This pain gets worse if you lie down but gets better if you sit down and lean forwards. Other symptoms may include a fever (high temperature) or breathlessness. Your doctor may give you non-steroidal anti-inflammatory drugs (NSAIDs) to ease the pain. Sometimes, they may also give you other medicines, such as colchicine or corticosteroids.

    If you have myocarditis, you may have chest pain, breathlessness and palpitations (thumping in your chest). You may not need any medicines as the condition often goes away on its own. But your doctor may advise you to take a break from strenuous exercise for several months while you recover. This is to help to prevent any abnormal heart rhythms. Occasionally, myocarditis can make your heart weaker (cardiomyopathy).

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Related information

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    • Acute pericarditis. Medscape., updated April 2019
    • Chest pain. Clinical Knowledge Summaries., last revised January 2017
    • Electrocardiography. Medscape., updated March 2019
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    • Autoimmune disorders. The MSD Manuals., last full review/revision January 2018
    • Chronic pericarditis. PatientPlus., last edited November 2016
    • Adler Y, Charron P, Imazio M, et al. Post-cardiac injury syndromes. 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., accessed July 2019
    • Myocarditis. PatientPlus., last edited January 2017
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    • Personal Communication. Dr Tim Cripps, Consultant Cardiologist, September 2019
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  • Reviewed by Graham Pembrey, Lead Editor, Health Content Team, September 2019
    Expert reviewer Dr Tim Cripps, Consultant Cardiologist
    Next review due September 2021