Pericarditis

Pericarditis is inflammation of the sac that surrounds the heart. Find out what causes pericarditis and learn about its diagnosis and treatment.

What is pericarditis?

Pericarditis is inflammation of the lining around the heart, called the pericardium.

The pericardium is a sac surrounding the heart that constitutes two thin layers. It helps to hold the heart in place inside the chest wall and helps the heart to work.

Normally, a small amount of fluid keeps the layers separate. If you have pericarditis, the sac becomes inflamed, and the amount of fluid between the two layers of the pericardium can increase. This increase in fluid can be large enough to press on the heart and stop it from pumping as well as it should.

What causes pericarditis?

The most common cause of pericarditis is a viral infection such as the flu or Covid-19. In other cases, it can be caused by:

• an injury to the chest

• heart surgery

• autoimmune disorders, such as rheumatoid arthritis or lupus

• bacterial or fungal infections

• cancer

• heart attack

• kidney failure

• radiation treatment

• some medications.

Types of pericarditis

There are two types of pericarditis - acute and chronic.

Acute pericarditis develops suddenly, with symptoms starting rapidly.

Chronic pericarditis lasts for three months or longer.

Pericarditis symptoms

The most common symptom is chest pain. This may include:

• pain in the left side of your chest which can spread to the shoulder and arms and may be relieved by leaning forward

• chest pain that feels worse when swallowing or coughing

• a sharp and stabbing pain caused by the heart rubbing on the pericardium

• pain behind the breastbone.

Other symptoms can include:

• dry cough

• feeling dizzy or lightheaded

• fainting

• feeling weak and tired

• fever

• flu-like symptoms (viral pericarditis)

• fast or irregular heartbeat

• shortness of breath or difficulty breathing made worse by lying down.

How is pericarditis diagnosed?

The doctor will ask about your medical history, symptoms, and when they began. They will also conduct a physical examination, including listening to your chest with a stethoscope.

Other tests may include:

• blood tests to check for inflammation and heart muscle damage

• ECG (Electrocardiograph) to check the heart’s rhythm and to look for changes which might indicate pericarditis

• chest x-ray to look at the heart size and rule out other possible conditions, such as a chest infection

• echo (an ultrasound of the heart) to check heart muscle function and the pericardial space.

Other tests, such as a cardiac MRI, may be performed occasionally.

How is pericarditis treated?

Treatment for acute pericarditis

Treatment for acute pericarditis may include the following:

• antibiotics – if caused by a bacterial infection

• colchicine – an anti-inflammatory medication that reduces inflammation, minimises the length of your symptoms and prevents the condition from re-occurring

• corticosteroids – can be used if colchicine isn’t working to reduce your symptoms

• rest – to reduce inflammation and allow recovery

• non-steroidal anti-inflammatories (NSAIDs) such as aspirin – to reduce pain and inflammation.

Occasionally, doctors may perform pericardiocentesis (details below).

Treatment for chronic pericarditis

On rare occasions, a procedure or surgery is required. These include:

• Pericardiocentesis (pericardial window) – a procedure that drains the excess fluid by inserting a thin tube (catheter) into the pericardium

• Pericardiectomy – surgery to remove some of the pericardia.

What is the recovery time for pericarditis?

Recovery time for pericarditis varies from person to person. In most cases, pericarditis is mild, and you will recover within a few weeks. For some people, however, it can take several months.

With chronic pericarditis, which can last for three months or longer, fluid can build up, and scarring and constriction (tightness) can occur. You may need to continue taking the NSAID or colchicine until the condition has resolved.

Your body will need time to rest and fully recover. You should avoid strenuous physical activity. It is usually recommended that you avoid high-intensity exercise for at least three months. Discuss this with your doctor.

If you have trouble sleeping because of the discomfort, take pain relief before bed. Sleeping upright can be more comfortable.