Pericarditis

Overview

Pericarditis is a condition where the thin, two-layered sac protecting your heart, called the pericardium, becomes inflamed or swollen. This swelling can cause friction and sharp chest pain, which is the main symptom that brings people to the doctor. You should know that in the vast majority of cases, about 85 to 90 percent of the time, this condition is mild and clears up completely within a few weeks. Recognizing the pain and getting simple treatment, often just rest and common anti-inflammatory medicines, puts you on the path to feeling better quickly.

The pericardium’s job is to hold the heart in place and keep it lubricated. When you get pericarditis, doctors classify the condition based on how long it lasts. Knowing the type helps your doctor decide on the best monitoring and treatment plan for you:

• Acute Pericarditis. This is the most common type and starts suddenly, lasting less than three weeks.
• Incessant Pericarditis. This means the swelling lasts longer, between four to six weeks, but does not come back after treatment stops.
• Recurrent Pericarditis. The swelling goes away and then returns at least four to six weeks after you finish the first treatment.
• Chronic Pericarditis. The swelling lasts for more than three months.

Symptoms

The most important pericarditis symptom you will notice is a sharp, stabbing pain in your chest, often starting suddenly in the center or left side of your chest. This chest pain often feels worse when you lie down flat, take a deep breath, or cough, and usually feels much better when you lean forward and sit up. Sometimes, you might also feel tired, weak, and even have a low-grade fever, like you are fighting off a cold or the flu. You must pay attention to these signs because they help doctors know exactly what is causing your discomfort.

Besides the main symptom of pain, the inflammation around your heart can cause other uncomfortable signs as your body works to fight the swelling. These signs might make you feel generally unwell and indicate your body is actively fighting an infection:

• Low-grade fever. A slight temperature that appears as your body’s defense system is active.
• Weakness and fatigue. Feeling very tired and drained of energy.
• Shortness of breath. Having difficulty breathing deeply because the deep breath makes the chest pain worse.
• Heart palpitations. Feeling like your heart is skipping a beat, fluttering, or pounding rapidly in your chest.

Causes

Many different things can be the underlying cause of pericarditis, but the most common reason is actually a viral infection, like the ones that give you a cold, the stomach flu, or COVID-19. Sometimes, you can get pericarditis after a major injury or surgery to your chest or heart, or from other conditions that affect your body’s immune system. Even though doctors often do not find the exact germ, the good news is that your body’s response is generally what is creating the swelling, and your body can manage it. Most of the time, your body handles the infection, and the swelling goes down naturally.

While viruses are the most frequent pericarditis causes, the swelling can also happen because of other health issues or events. Your doctor will carefully investigate your health history to look for other possible triggers:

• Bacterial or fungal infections. Less common, but sometimes a specific germ causes the inflammation.
• Autoimmune diseases. Conditions where your body attacks its own tissues, such as lupus or rheumatoid arthritis.
• Injury. Trauma to your chest after an accident.
• Metabolic problems. Conditions like kidney failure that cause waste products to build up in your body.
• Following a heart attack. Inflammation can occur in the days or weeks after a heart muscle injury.

Diagnosis

When you go to the doctor, they will use several simple tests to confirm your pericarditis diagnosis and rule out other serious problems. First, your doctor listens carefully to your chest using a stethoscope and may hear a unique scratching sound, which doctors call a “pericardial rub.” They also use tests like the electrocardiogram (ECG), which records your heart’s electrical activity and shows specific changes caused by the swelling. Your doctor confirms the diagnosis by putting together your symptoms, the physical exam, and the results of these quick and usually painless tests.

To investigate the swelling and check your heart, your doctor relies on several key tools. Each test provides a different piece of information necessary for the most accurate pericarditis diagnosis:

• Electrocardiogram (ECG). This is a quick and painless test where sticky patches are placed on your skin to check the electrical signals of your heart and look for changes caused by the inflammation.
• Echocardiogram (Echo). This special ultrasound uses sound waves to create a moving picture of your heart and its surrounding sac. This test shows if fluid is building up in the pericardium.
• Chest X-ray. This picture helps check the shape and size of your heart and lungs, showing if the heart sac is noticeably larger due to fluid buildup.
• Blood Tests. These tests look for signs of inflammation in your body and help identify specific underlying causes, such as a high white blood cell count indicating an infection.

Treatment

The goal of pericarditis treatment is to reduce the swelling and manage the pain, and you usually feel better quickly once you start the simple medication. Most people only need to take common nonsteroidal anti-inflammatory drugs (NSAIDs), which are medicines like ibuprofen that reduce both the pain and the swelling. Your doctor might also give you a medicine called colchicine, which is great at keeping the swelling from coming back later. Remember that the best medicine for the body to heal is actually rest, so you should listen to your body and take it easy while you are recovering.

Your doctor decides the best combination of treatment for pericarditis based on how you feel and the likely cause. The typical approach involves specific medications and careful management:

• Anti-inflammatory Medications (NSAIDs). These are the standard treatment to quickly calm down the irritation and inflammation in the pericardium and reduce pain.
• Colchicine. This medicine is often added to the treatment plan because it specifically helps prevent the inflammation from returning, which is especially useful if you have recurrent pericarditis.
• Rest. You must limit your physical activity until the swelling is completely gone. Pushing yourself too hard can bring the pain back or make the condition last longer.
• Specific Procedures (Rare). In the rare case that the swelling causes a lot of fluid to build up and press on the heart, a procedure called pericardiocentesis is performed. This is when the doctor uses a small needle to carefully drain the extra fluid from the sac around your heart to relieve the pressure immediately.

Risks

While most people recover completely, you should know about the potential pericarditis risks, though they are very rare, especially when you receive prompt treatment. The biggest concerns are related to the fluid that can build up around the heart. You must understand that these serious problems happen to very few people, particularly if you follow your doctor’s treatment plan and rest properly. Staying in touch with your doctor helps monitor you closely and ensures that you avoid these long-term issues.

These two serious complications are the primary concerns that your doctor watches for, though they happen to only a small number of people who experience pericarditis risks:

• Cardiac Tamponade. This is a serious, life-threatening condition that happens when too much fluid collects in the sac, putting critical pressure on the heart. This pressure prevents the heart from filling properly with blood and pumping effectively, requiring immediate medical help to drain the fluid.
• Constrictive Pericarditis. This is a condition that occurs if the swelling becomes chronic and causes the pericardium sac to thicken, scar, and become stiff. This hard, stiff sac prevents the heart muscle from expanding properly when it beats, and it requires long-term management or sometimes surgery to fix.

Prevention

Because the main cause of pericarditis is usually a viral infection, focusing on general health steps is the best path to prevention and keeping your body strong. You can reduce your risk by practicing excellent hygiene, such as washing your hands often with soap and water to avoid spreading germs and infections. If you have another health issue that can lead to this swelling, like an autoimmune condition, staying on top of that treatment helps prevent heart-related problems. You take control of your health when you follow these simple, healthy routines.

To focus on pericarditis prevention, you should treat your body well to boost your natural defenses and avoid catching and spreading common viruses. You can take these actions to strengthen your resistance:

• Practice Good Hygiene. Always wash your hands thoroughly, especially before eating and after being in public places, to limit viral spread.
• Manage Existing Conditions. If you have an autoimmune disease or other chronic health problems, make sure you take your prescribed medications regularly to keep your body balanced.
• Avoid Overexertion. If you have an acute viral infection (like the flu), avoid intense exercise until you feel completely better, as pushing yourself may increase the chance of inflammation reaching the heart.
• Finish Treatment. If you have already had an episode, take all medications prescribed by your doctor (like colchicine) for the full duration to stop the swelling from returning.

When to See a Doctor

You must know when to see a doctor for pericarditis symptoms, especially if you suddenly feel a sharp, new chest pain. Any time you feel a new and severe chest pain, you should go to the emergency room immediately to get checked out, as it could be something else serious that needs urgent attention. You should also call your doctor if you have been treated for pericarditis but the pain suddenly gets much worse or you have trouble breathing and feel lightheaded. Do not wait for chest pain to go away; getting checked quickly helps doctors give you the right treatment immediately.

While most cases are mild, there are specific warning signs that mean you need immediate medical attention. If you experience the pain of pericarditis, seek care immediately, and call emergency services if you notice any of these more serious when to see a doctor symptoms:

• Sudden, severe chest pain. Especially pain that spreads to your neck, shoulder, or arm.
• Fainting or severe lightheadedness. Feeling like you might pass out.
• Difficulty breathing. Struggling to catch your breath or breathing rapidly.
• Pain that does not get better. Pain that fails to improve even after taking your prescribed anti-inflammatory medication and resting.
• Fever and chills. If your temperature goes high and your body shakes, it can signal a more severe type of infection.

Reference: Pericarditis