Pericarditis is inflammation of the pericardium—the thin protective sac that surrounds your heart. This condition can cause symptoms like chest pain and breathing difficulty. About 5% of people with acute (new or sudden) chest pain have pericarditis.
Pericarditis typically occurs after an infection. Taking over-the-counter pain relievers and resting will often help reduce symptoms. However, some people may require prescription treatments and in rare cases, surgery, to manage their symptoms.
Pericarditis is divided into types based on the known cause. Idiopathic pericarditis has no known cause. Other types of pericarditis include:
- Infectious: Caused by a virus, bacteria, or fungi
- Traumatic: Caused by physical injury to your chest, like blunt force
- Malignant: Caused by cancer
- Uremic: Caused by kidney failure
It is further classified based on how long symptoms have been present.
Here are the four common classifications of pericarditis:
- Acute: Symptoms last no more than four to six weeks. The pain usually develops suddenly and may be due to a known or unknown cause.
- Incessant: Consistent symptoms last longer than four to six weeks.
- Recurrent: You have a history of pericarditis, and symptoms begin again after four to six weeks without any symptoms. This is also known as refractory pericarditis.
- Chronic: Consistent symptoms last longer than three months. Chronic pericarditis can be especially problematic because the symptoms can lead to complications, such as thickening or scarring of the pericardial tissue around your heart. The thickened tissue can constrict the heart and affect how it functions.
Recurrent pericarditis accounts for about 30% of pericarditis diagnoses.
Pericarditis symptoms include:
- Central chest pain that usually gets worse when inhaling (breathing in) or lying down
- Fast heart rate
- Heart palpitations (feeling like your heart is fluttering in your chest)
- Problems swallowing
- Frequent hiccups
- Feeling faint
Chest pain is the most common pericarditis symptom. You may think you’re having a heart attack. However, heart attack pain is caused by ischemia, or lack of blood flow. Pericardial chest pain is caused by nerve irritation and inflammation.
There are several key symptom differences between pericardial pain and ischemic chest pain. Ischemic pain is generally worse with physical activity and better with rest. The pain doesn't change based on the position of your body. Pericardial pain typically gets worse when you lie down, and it tends to improve when you sit up and lean forward.
Acute, chronic, incessant, or recurrent pericarditis share the same symptoms. The only difference is the length of time you experience those symptoms.
Most pericarditis is idiopathic, meaning the causes are unknown. However, it can occur after some type of infection—usually a viral infection like a chest cold or pneumonia (an infection in one or both lungs that may cause them to fill with mucus).
Some conditions have been linked to pericarditis. For example, about 80-85% of acute pericarditis cases are likely due to a virus such as an upper respiratory infection or gastroenteritis (an intestinal infection).
Other possibly related conditions include:
- Autoimmune conditions, which are conditions in which your body attacks its own healthy tissue
- Cancer, including lung cancer, breast cancer, and lymphoma (blood cancer in your lymph system, a part of your immune system that helps your body fight foreign substances)
- Hypothyroidism, a condition where your thyroid doesn’t make enough thyroid hormone (also known as underactive thyroid)
- Inflammation after a cardiac procedure, such as coronary artery bypass grafting (a medical procedure that helps restore blood flow to the heart) or pacemaker insertion. A pacemaker is an implantable device that continually monitors and helps restore your heart's regular rate and rhythm with electrical shocks.
Tuberculosis is a common cause of pericarditis in developing countries like sub-Saharan Africa. The bacteria that causes tuberculosis can infect the cells in the pericardium, leading to symptoms like chest pain.
While pericarditis can affect people of all ages, people assigned male at birth between the ages 16 and 65 are at greater risk of developing the condition.
Other potential risk factors include:
- Medical conditions like kidney failure, tuberculosis (a serious condition that primarily affects your lungs), cancer, and human immunodeficiency virus (HIV)
- Previous heart surgery or radiation therapy
- History of a traumatic accident, such as blunt force trauma to your chest
Certain medications might also increase your risk of experiencing pericarditis, including:
- Epanutin (phenytoin): A medication used to treat seizures
- Coumadin or Jantoven (wayfarin) and Lovenox and Fragmin (heparin): Blood-thinning medications that treat and prevent blood clots
- Pronestyl (procainamide): A medication used to treat irregular heartbeats
Pericarditis is usually diagnosed and treated by a cardiologist, a doctor who specializes in conditions that affect your cardiovascular system (heart and blood vessels).
Two of four symptoms must be present to diagnose acute pericarditis. These symptoms include:
- Chest pain: An estimated 80% to 90% of people with pericarditis experience sudden and sharp chest pain. Sitting up may reduce this symptom, and deep breathing or coughing usually worsens symptoms.
- Pericardial rub: A pericardial rub is a unique sound a healthcare provider can hear when listening to your heart. The sound is caused by pericardial layers rubbing together
- Electrocardiogram (EKG or ECG) changes: An EKG or ECG is a test that measures the electrical activity of your heart. About 60% of people with pericarditis have very distinct EKG changes.
- New or worsening pericardial effusion: Pericardial effusion is a buildup of fluid around the heart. Inflammation related to pericarditis can lead to pericardial effusion. An effusion might also be diagnosed based on imaging, such as an echocardiogram. An echocardiogram is an ultrasound that takes images of your heart’s structure.
A cardiologist may also rule out other conditions that may have symptoms similar to pericarditis, including:
- Gastroesophageal reflux disease (GERD): GERD occurs when acid moved upward from your stomach into your esophagus, and sometimes your mouth. This condition can cause a burning discomfort in your chest, similar to pericarditis.
- Heart attack: A heart attack occurs when your heart doesn’t get enough oxygen and blood. Like pericarditis, chest pain is a common symptom. However, pain related to pericarditis usually gets worse with deep breathing and when lying down, while heart attack pain is generally more consistent.
- Myocarditis: Myocarditis is inflammation of your heart muscle while pericarditis is inflammation of your heart’s lining. Both cause symptoms like chest pain, shortness of breath, and feeling faint. You can have both conditions at the same time, which is called myopericarditis.
- Pneumonia: Pneumonia is a lung infection. Like pericarditis, it can cause pain when breathing. However, unlike pericarditis, you are more likely to experience symptoms like shortness of breath and coughing.
Anti-inflammatory medications are typically prescribed to reduce pericarditis symptoms. They will also probably advise you to rest until symptoms resolve, especially if you have a fever.
Commonly prescribed medications include:
- Nonsteroidal anti-inflammatory drugs, such as Advil (ibuprofen) and aspirin: These are usually first-line treatments because they reduce pain.
- Colcrys (colchicine): This is a medication prescribed for gout (inflammatory arthritis) that can reduce pericardial pain. It is usually prescribed with non-steroidal anti-inflammatory drugs (NSAIDs) like Advil or aspirin because they tend to work better together.
- Corticosteroids: These anti-inflammatory medications, including prednisone, can reduce inflammation in the tissues outside your heart, reducing discomfort and symptoms.
- Interleukin-1 (IL-1) blockers: Medications like Kineret (anakinra), which are used for inflammatory conditions like rheumatoid arthritis, can be especially helpful for people who may not be able to take NSAIDs or colchicine. These medications stop specific proteins from working, which can help reduce inflammation.
Antimicrobial therapies, such as antibiotics, might be used to treat pericarditis caused by a bacterial infection.
While most episodes of pericarditis resolve in a few weeks, persistent pericarditis that causes painful and life-altering symptoms may require surgery. The surgical treatment for recurrent pericarditis is pericardectomy, or surgical removal of the pericardium.
Most pericarditis causes are unknown, which makes prevention difficult. It’s also difficult to prevent necessary surgeries or traumatic accidents that might contribute to pericarditis.
Some medications, such as Epanutin and Coumadin, can increase your risk of pericarditis. Talk to your healthcare provider about the potential benefits and risks of trying other medications, and always talk to your healthcare provider before stopping any medicines.
While you may not be able to prevent an acute pericarditis episode, you can talk to your healthcare provider about preventing recurrent pericarditis. Ask if you should try taking NSAIDs, Colcrys, or other anti-inflammatory medications on a regular basis to prevent recurrent episodes.
The most common conditions that co-occur with pericarditis include hypertension (high blood pressure), chronic kidney disease, and diabetes mellitus. These conditions can cause inflammation and changes to your heart that could potentially increase your risk of pericarditis. However, people without these conditions can also experience pericarditis.
Pericarditis can also occur as a result of rheumatic and connective tissue diseases, such as:
- Systemic lupus erythematosus: The most common form of lupus, an autoimmune disease in which your body attacks its own healthy tissue
- Rheumatoid arthritis: An autoimmune disease that causes joint pain and inflammation
- Fibromyalgia: A chronic condition that causes pain throughout your body, as well as symptoms like fatigue
These conditions cause inflammation and possibly an immune response that damages pericardial tissue, leading to pericarditis.
In rare cases, pericarditis can lead to more serious complications. These include cardiac tamponade and constrictive pericarditis. Cardiac tamponade is pressure in your heart due to a buildup of fluid between your heart muscle and pericardium. Constrictive pericarditis is the thickening or scarring of the pericardial tissue around your heart. Both of these conditions affect how your heart functions and can be life-threatening.
Living With Pericarditis
Acute pericarditis symptoms generally resolve on their own, and you might not experience them again. Resting and taking NSAIDs are usually sufficient treatments. However, an estimated 50% of people who require steroid treatments after the first pericarditis episode may still have a recurrence of pericarditis.
If you have recurrent pericarditis, your healthcare provider may prescribe additional medications to help alleviate symptoms. While it may take several months to recover from recurrent pericarditis, consistently taking your medications and following your healthcare provider’s other treatment recommendations will help the recovery process.
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