Pericarditis
Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.
Pericarditis
Pericarditis is a disorder caused by inflammation of the pericardium, the sac-like covering of the heart. Pericarditis can be caused by bacterial, fungal, or viral infections. It may also be a result of injury or trauma to the chest, esophagus, or heart. Pain occurs as a result of the inflamed pericardium rubbing against the heart.
Causes
The cause of pericarditis is unknown or unproven in many cases. It mostly affects men ages 20 to 50 years.
Pericarditis is often the result of an infection such as:
- Viral infections that cause a chest cold or pneumonia
- Infections with bacteria (less common)
- Some fungal infections (rare)
The condition may be seen with diseases such as:
- Cancer (including leukemia)
- Disorders in which the immune system attacks healthy body tissue by mistake (autoimmune diseases)
- HIV infection and AIDS
- Underactive thyroid gland
- Kidney failure
- Rheumatic fever
Rheumatic fever
Rheumatic fever is a disease that may develop after an infection with group A streptococcus bacteria (such as strep throat or scarlet fever). It can...
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Other causes include:
- Heart attack
Heart attack
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...
ImageRead Article Now Book Mark Article - Heart surgery or trauma to the chest, esophagus, or heart
- Certain medicines, such as procainamide, hydralazine, phenytoin, isoniazid, and some drugs used to treat cancer or suppress the immune system
- Swelling or inflammation of the heart muscle (myocarditis)
- Radiation therapy to the chest
Symptoms
Chest pain is almost always present. The pain:
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
- May be felt in the neck, shoulder, back, or abdomen
- Often increases with deep breathing and lying flat, and may increase with coughing and swallowing
- Can feel sharp and stabbing
- Is often relieved by sitting up and leaning or bending forward
You may have fever, chills, or sweating if the condition is caused by an infection.
Other symptoms may include:
- Ankle, feet, and leg swelling
Ankle, feet, and leg swelling
Painless swelling of the feet and ankles is a common problem, especially among older people. Abnormal buildup of fluid in the ankles, feet, and legs ...
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Anxiety
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
ImageRead Article Now Book Mark Article - Breathing difficulty when lying down
- Dry cough
- Fatigue
Exams and Tests
When listening to the heart with a stethoscope, the health care provider can hear a sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of excess fluid in the pericardium (pericardial effusion).
Heart sounds
A heart murmur is a blowing, whooshing, or rasping sound heard during a heartbeat. The sound is caused by turbulent (rough) blood flow through the h...
If the disorder is severe, there may be:
- Crackles in the lungs
- Decreased breath sounds
- Other signs of fluid in the space around the lungs
The following imaging tests may be done to check the heart and the tissue layer around it (pericardium):
- Chest MRI scan
Chest MRI scan
A chest MRI (magnetic resonance imaging) scan is an imaging test that uses powerful magnetic fields and radio waves to create pictures of the chest (...
ImageRead Article Now Book Mark Article - Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
ImageRead Article Now Book Mark Article - Echocardiogram
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
ImageRead Article Now Book Mark Article - Electrocardiogram (ECG)
Electrocardiogram
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
ImageRead Article Now Book Mark Article - Heart MRI or heart CT scan
Heart MRI
Heart magnetic resonance imaging is an imaging method that uses powerful magnets and radio waves to create pictures of the heart. It does not use ra...
ImageRead Article Now Book Mark ArticleCT
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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To look for heart muscle damage, the provider may order a troponin I test. Other laboratory tests may include:
- Antinuclear antibody (ANA)
- Blood culture
Blood culture
A blood culture is a laboratory test to check for bacteria or other germs in a blood sample.
ImageRead Article Now Book Mark Article - CBC
CBC
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
ImageRead Article Now Book Mark Article - C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
ESR
ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate. "It is a test that indirectly measures the level of certain protei...
ImageRead Article Now Book Mark Article - HIV test
- Rheumatoid factor
- Tuberculin skin test
Treatment
The cause of pericarditis should be identified, if possible.
High doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin are often given with a medicine called colchicine. These medicines will decrease your pain and reduce the swelling or inflammation in the sac around your heart. You will be asked to take them for days to weeks or longer in some cases.
If the cause of pericarditis is an infection:
- Antibiotics will be used for bacterial infections
- Antifungal medicines will be used for fungal pericarditis
Other medicines that may be used are:
- Corticosteroids such as prednisone (in some people)
- "Water pills" (diuretics) to remove excess fluid
- Other anti-inflammatory agents
If the buildup of fluid makes the heart function poorly, treatment may include:
- Draining the fluid from the sac. This procedure, called pericardiocentesis, is done using a needle, which is guided by ultrasound (echocardiography) in most cases.
Pericardiocentesis
Pericardiocentesis is a procedure that uses a needle to remove fluid from the pericardial sac. This is the tissue that surrounds the heart.
ImageRead Article Now Book Mark Article - Cutting a small hole (window) in the pericardium (subxiphoid pericardiotomy) to allow the infected fluid to drain into the abdominal cavity. This is done by a surgeon.
Surgery called pericardiectomy may be needed if the pericarditis is long-lasting, comes back after treatment, or causes scarring or tightening of the tissue around the heart. The operation involves cutting or removing part of the pericardium.
Outlook (Prognosis)
Pericarditis can range from mild illness that gets better on its own, to a life-threatening condition. Fluid buildup around the heart and poor heart function can complicate the disorder.
The outcome is good if pericarditis is treated right away. Most people recover in 2 weeks to 3 months. However, pericarditis may come back. This is called recurrent, or chronic, if symptoms or episodes continue.
Scarring and thickening of the sac-like covering and the heart muscle may occur when the problem is severe. This is called constrictive pericarditis. It can cause long-term problems similar to those of heart failure.
Constrictive pericarditis
Constrictive pericarditis is a process in which the sac-like covering of the heart (the pericardium) becomes thickened and scarred. Related conditio...
When to Contact a Medical Professional
Contact your provider if you have symptoms of pericarditis. This disorder is not life threatening most of the time. However, it can be very dangerous if not treated.
Prevention
Many cases cannot be prevented.
Reviewed By
Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Azarbal A, LeWinter MM. Pericarditis. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2024. Philadelphia, PA: Elsevier; 2024:148-152.
Chabrando JG, Bonaventura A, Vecchie A, et al. Management of acute and recurrent pericarditis: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(1):76-92. PMID: 31918837 pubmed.ncbi.nlm.nih.gov/31918837/.
Knowlton KU, Savoia MC, Oxman MN. Myocarditis and pericarditis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 80.
Lewinter MM, Cremer PC, Klein AL. Pericardial diseases. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 86.
