Pericarditis Overview

Pericarditis is inflammation of the pericardium, the thin sac-like membrane surrounding the heart that holds it in place and protects it from infection or injury. This condition often causes sharp chest pain and can range from mild and self-resolving to severe with complications like fluid buildup or heart compression.

What Is the Pericardium?

The pericardium is a double-layered fibroelastic sac enveloping the heart, consisting of an inner visceral layer adherent to the epicardium and an outer parietal layer separated by 15-50 mL of serous fluid that reduces friction during heartbeats. This structure cushions the heart, prevents overexpansion, and serves as a barrier against infection and malignancy. Inflammation disrupts this fluid balance, leading to painful rubbing of layers and potential effusion.

Pericarditis Symptoms

The hallmark symptom of pericarditis is sharp, stabbing chest pain, typically located in the middle or left chest, radiating to shoulders or neck, worsening when lying down or breathing deeply, and improving when leaning forward. Other common signs include:

• Shortness of breath or fatigue
• Fever, persistent cough, or night sweats
• Irregular heartbeat (palpitations)
• A high-pitched ‘friction rub’ sound heard via stethoscope when leaning forward

In severe cases with large pericardial effusion, low blood pressure, shock, or cardiac tamponade may occur, compressing the heart and impairing pumping—a medical emergency. Up to 90% of patients report chest discomfort.

Causes of Pericarditis

Pericarditis arises from infectious or non-infectious triggers, with many cases idiopathic (unknown cause). Causes are grouped as follows:

Infectious Causes

• Viral infections (most common in developed countries, e.g., coxsackievirus, COVID-19)
• Bacterial (e.g., tuberculosis in endemic areas, staphylococcus)
• Fungal or parasitic (rare, in immunocompromised)

Non-Infectious Causes

• Heart attack, surgery, or procedures (post-MI Dressler’s syndrome)
• Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
• Cancer (lung, breast), radiation therapy, or uremia
• Trauma, medications (e.g., hydralazine), or kidney failure

Risk increases post-heart injury, viral illness, or in males aged 20-50.

Types of Pericarditis

Pericarditis is classified by duration and recurrence:

• Acute: Sudden onset, lasts <4-6 weeks
• Incessant: Persists 4-6 weeks to <3 months despite treatment
• Chronic: Lasts >3 months
• Recurrent: New episode after 4-6 weeks symptom-free; affects 15-30%

Associated syndromes include effusive-constrictive (effusion + constriction) or constrictive pericarditis (thickened sac restricts filling).

Diagnosis

Diagnosis requires at least two of four criteria: typical chest pain, pericardial friction rub, ECG changes (diffuse ST elevation, PR depression), or new/large effusion. Steps include:

• Physical exam for rub, fever, or muffled sounds
• ECG: Stage I concave ST elevation (vs. convex in MI), PR depression in multiple leads
• Echocardiogram: Detects effusion, tamponade signs (chamber collapse)
• Blood tests: Elevated CRP/ESR (inflammation), troponin (if myopericarditis)
• Advanced: CT/MRI for etiology, pericardiocentesis if tamponade or purulent

Differentiate from MI (ECG, troponin), PE, or pneumonia.

Treatment

Treatment targets inflammation and cause; most acute cases resolve with rest and meds. First-line:

• High-dose NSAIDs (ibuprofen 600-800mg TID) or aspirin for 1-2 weeks
• Colchicine (0.5mg BID) for 3 months to prevent recurrence (reduces risk by 50%)

Second-line if refractory:

• Corticosteroids (prednisone 0.2-0.5mg/kg) cautiously, as they increase recurrence
• Immunosuppressants (azathioprine, IVIG) for autoimmune/recurrent

For complications:

• Pericardiocentesis/drain for tamponade or large effusion
• Antibiotics/antifungals for infection; pericardiectomy for constriction

Hospitalize high-risk patients (fever, subacute, effusion, trauma, anticoagulation).

Complications

Untreated pericarditis risks:

• Pericardial effusion: Fluid buildup; rapid/large leads to tamponade (hypotension, shock)
• Constrictive pericarditis: Scarred sac impairs filling; 30% risk post-bacterial/TB
• Myopericarditis: Myocardial involvement (elevated troponin)

Prognosis and Recovery

Acute pericarditis has excellent prognosis; 80-90% resolve in weeks with treatment. Recovery varies by cause/health: mild cases self-resolve with rest; severe may take months. Recurrence risk 15-30%; monitor with follow-up echo/ECG. Chronic cases or post-TB have higher constriction risk (up to 30%). Most patients return to normal activity post-recovery.

Prevention

Prevent by treating underlying conditions (e.g., prompt viral care, TB screening). Post-cardiac injury/surgery, early anti-inflammatories reduce risk. Colchicine prevents recurrence in high-risk. Lifestyle: Avoid triggers like certain meds; vaccinate against viruses.

When to See a Doctor

Seek immediate care for chest pain mimicking heart attack (call 911). Urgent evaluation for new pain worsening with position/breathing, fever, dyspnea, or palpitations.

Frequently Asked Questions (FAQs)

What does pericarditis chest pain feel like?

Sharp, stabbing pain in the chest or left side, worse lying down or breathing deeply, better leaning forward.

Is pericarditis life-threatening?

Usually not; most cases mild. But tamponade or constriction can be emergencies requiring intervention.

How long does pericarditis last?

Acute: <4-6 weeks; full recovery 1-3 months with treatment.

Can COVID-19 cause pericarditis?

Yes, as a viral trigger, especially post-vaccination or infection.

Can pericarditis be cured?

Yes, most acute cases resolve fully; chronic/recurrent managed long-term.

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Author

Sneha TeteBeauty & Lifestyle Writer

 

Sneha is a relationships and lifestyle writer with a strong foundation in applied linguistics and certified training in relationship coaching. She brings over five years of writing experience to renewcure,  crafting thoughtful, research-driven content that empowers readers to build healthier relationships, boost emotional well-being, and embrace holistic living.

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