Pericarditis is a condition in which the pericardium—the thin, protective sac surrounding the heart—becomes inflamed. This inflammation can cause sharp chest pain and other symptoms that often worsen with deep breathing or lying flat and improve when sitting up or leaning forward.
Pericarditis can be acute and self-limited, or it can recur over time. While many cases resolve with appropriate treatment, early recognition is important to prevent complications.
How Pericarditis Affects the Heart
The pericardium consists of two thin layers with a small amount of lubricating fluid between them. In pericarditis, inflammation makes these layers rough, causing them to rub against each other with each heartbeat. This friction is responsible for the characteristic chest pain.
Inflammation may also increase fluid production within the pericardial space, leading to pericardial effusion. In rare cases, rapid or excessive fluid accumulation can impair the heart’s ability to fill properly.
Common Causes of Pericarditis
Pericarditis has many possible causes, but in most cases a specific cause is not identified.
Common causes include viral infections, immune-mediated or inflammatory conditions, recent heart attack or heart surgery, kidney disease, certain medications, and systemic illnesses. In many patients, pericarditis is classified as idiopathic, meaning no clear cause is found despite evaluation.
Symptoms of Pericarditis
Chest pain is the hallmark symptom of pericarditis. The pain is often sharp or stabbing and may radiate to the neck, shoulder, or back.
Typical features include:
- Chest pain that worsens with deep breathing, coughing, or lying flat
- Pain that improves when sitting up or leaning forward
- Shortness of breath, especially when reclining
- Low-grade fever or flu-like symptoms
- Palpitations
Because chest pain can have many causes, medical evaluation is essential to confirm the diagnosis.
How Pericarditis Is Diagnosed
Diagnosis is based on clinical features, physical examination, and testing. A characteristic friction sound may be heard on heart examination.
Electrocardiography often shows typical changes associated with pericardial inflammation. Echocardiography is used to assess heart function and detect pericardial effusion.
Blood tests may reveal signs of inflammation, and imaging studies help rule out other causes of chest pain and guide management.
Treatment Options for Pericarditis
Treatment depends on the severity of symptoms, underlying cause, and risk of recurrence.
Anti-Inflammatory Therapy
Most cases are treated with anti-inflammatory medications aimed at reducing pericardial inflammation and relieving pain. These therapies are usually continued for a defined period and tapered gradually to reduce the risk of recurrence.
Duration of Treatment and Recovery
The duration of treatment for pericarditis varies depending on the cause, severity, and risk of recurrence. In uncomplicated acute pericarditis, anti-inflammatory treatment is typically continued for several weeks, often until symptoms resolve and inflammatory markers normalize. Gradual tapering of medication is important to reduce the risk of recurrence.
In cases of recurrent or persistent pericarditis, treatment may need to be continued for several months, with careful adjustment based on symptoms and follow-up testing. Activity restriction usually lasts longer than pain relief alone, and return to full physical activity is guided by clinical recovery rather than symptom improvement alone.
Regular follow-up is essential to monitor response to treatment, detect complications early, and determine when therapy can be safely reduced or stopped.
Activity Restriction and Recovery
Physical rest is an important part of treatment. Patients are typically advised to avoid strenuous activity until symptoms and inflammatory markers resolve. Returning to intense activity too early can prolong inflammation or trigger recurrence.
Management of Complications
If significant pericardial effusion develops, close monitoring is required. Pericardial effusion refers to the abnormal accumulation of fluid in the space between the heart and the pericardium. Small amounts of fluid may cause no symptoms and can often be managed with observation and medical therapy.
However, if fluid accumulates rapidly or in large amounts, it can compress the heart and interfere with its ability to fill and pump blood effectively. This dangerous condition is known as cardiac tamponade and requires urgent treatment.
In such cases, a procedure called pericardiocentesis may be necessary. Pericardiocentesis involves inserting a thin needle or catheter into the pericardial space to drain excess fluid and immediately relieve pressure on the heart. This procedure is typically performed under imaging guidance and can be life-saving when heart function is compromised.
After fluid removal, ongoing monitoring is essential to prevent recurrence and address the underlying cause of the effusion.
Recurrent Pericarditis
Some patients experience recurrent episodes after initial recovery. Recurrent pericarditis requires careful management and prolonged anti-inflammatory therapy. The goal is to control inflammation while minimizing medication side effects and preventing further recurrences.
Prognosis and Long-Term Outlook
The outlook for pericarditis is generally good, especially when treated promptly. Most patients recover fully without long-term heart damage.
Chronic or recurrent forms require ongoing follow-up, but with modern treatment strategies, symptoms can usually be controlled and quality of life maintained.
When to Seek Medical Attention
New or worsening chest pain, shortness of breath, fainting, or persistent fever should prompt medical evaluation. Because pericarditis symptoms can mimic other serious heart conditions, timely assessment is essential.
In Summary
Pericarditis is inflammation of the protective sac surrounding the heart and often presents with characteristic chest pain. While many cases are mild and self-limited, proper diagnosis, anti-inflammatory treatment, and activity restriction are key to recovery and prevention of complications.
Reference: Pericarditis
