Pericarditis
Your health expert: Dr Joshua Chai, Consultant Cardiologist
Content editor review by Rachael Mayfield-Blake, Freelance Health Editor, December 2021.
Next review due December 2024.
Pericarditis is inflammation of the pericardium, which is the sac that surrounds and protects your heart. The main symptom is chest pain, which often gets better if you sit up and lean forward.
What is pericarditis?
Your pericardium helps your heart to work properly. It also protects your heart and holds it in place inside your chest. The pericardium has two layers with a small amount of fluid (pericardial fluid) between them. The pericardial fluid prevents the layers from rubbing against one another when your heart beats.
If your pericardium gets inflamed, excess fluid or blood may build up in it and cause pain. This is called pericarditis. People of all ages can get pericarditis but it’s more common in adults, particularly men. 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)
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. These include:
- autoimmune conditions such as rheumatoid arthritis and systemic lupus erythematosus; autoimmune conditions are when your immune system attacks your healthy tissues
- a heart attack
- bacterial infections, especially tuberculosis (TB)
- problems with your metabolism – for example, kidney failure and an underactive-thyroid (hypothyroidism)
- certain types of cancer, especially breast-cancer and lung-cancer
- reactions to certain medicines
- having dialysis treatment
- radiotherapy on your chest
- an injury to your chest from an accident or surgery
Often though, your doctors may not be able to work out exactly what’s causing your pericarditis.
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 forward. But the pain may spread to your neck and shoulders (especially your left shoulder), and to your tummy (abdomen). It tends to get worse if you lie down (particularly on your left side), breathe in, swallow or cough.
You may also have:
- a fever (raised temperature)
- a cough
- painful joints
- difficulty breathing
- extreme tiredness
- 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 (how you hold your body – for example, how you sit). It may feel different as you change your position.
The pain associated with a heart attack is less likely to be affected by posture. But heart attacks don’t always happen in a set way. It’s always best to seek medical advice as soon as possible.
Diagnosis of pericarditis
If you have symptoms of pericarditis and go to hospital, you may see 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 and help to show if 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.
- A CT scan or coronary angiogram. This can show if you have had a heart attack or have coronary heart disease.
- MRI scan. This 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. Your 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 and have 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 and could potentially cause an ulcer.
Your doctor may offer you a medicine called colchicine to help with the inflammation. Your doctor may also prescribe colchicine if you have recurrent pericarditis (when your condition comes back after a while). You may need to take colchicine for several months. This may keep your symptoms away for longer.
Some types of pericarditis can be treated with corticosteroid medicines, , but these aren’t suitable 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.
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
It’s important to get plenty of rest. Don’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’re normally very active and 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 the type of pericarditis you have and how severe it is, and the type of work you do. You may be able to go back to work that isn’t physically demanding after a few days, but you may need to take at least two weeks off. It will depend on lots of things. Your doctor will talk this through with you.
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 (see below). These two complications can happen together. The symptoms may be similar to pericarditis and can include difficulty breathing and swelling around your 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 around your heart, this can stop your heart from filling properly because the heart chambers are compressed by the fluid. 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.
Most people with pericarditis get better in six weeks. It usually clears up without any complications and doesn’t come back again. But sometimes, pericarditis can be more serious and lead to complications such as pericardial effusion or constrictive pericarditis.
For more information, see our section: Complications of pericarditis.
The most common cause of pericarditis is a viral infection but there are many other causes. These include a heart attack or problems with your metabolism such as kidney failure or an underactive thyroid (hypothyroidism). Sometimes, doctors can’t find a cause for pericarditis.
For more information, see our section: Causes of pericarditis.
It may well do. Pericarditis usually clears up within six weeks and doesn’t come back again. While you’re recovering, you may need some treatment, depending on what’s causing your pericarditis and how bad your symptoms are.
For more information, see our section: Treatment of pericarditis.
The main symptom of pericarditis is chest pain, which is usually constant and may be sharp, stabbing or aching. It often gets better if you sit up and lean forward, and gets worse if you lie down. You may have other symptoms such as a cough, difficulty swallowing and a fever (high temperature).
For more information, see our section: Symptoms of pericarditis.
The pain is in your chest. And it may spread to your neck and shoulders (especially your left shoulder), and to your tummy (abdomen). You may also have pain in your joints.
For more information, see our section: Symptoms of pericarditis.
Echocardiogram
Electrocardiogram (ECG)
An electrocardiogram (ECG) is a test that can record the rhythm and electrical activity of your heart to find out if it’s healthy.
Heart attack
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