Acute pericarditis is a form of pericarditis lasting less than four to six weeks and usually begins suddenly. While most patients recover fully, up to 30% may experience recurring chest pain. In most cases, the cause of the pericarditis remains unknown, or idiopathic.
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What is pericarditis?
Pericarditis is inflammation of the pericardium, a thin two-layered membrane that surrounds the heart and holds it in place. Fluid in the pericardium provides lubrication and reduces friction between the two layers of the lining. Pericarditis occurs when inflammation irritates the pericardium, potentially causing pain and/or fluid buildup around the heart.
Pericarditis is typically mild and may even go away on its own. Sometimes it occurs suddenly. Other times, it develops over a long period of time. Without proper treatment, pericarditis could lead to excess fluid around the heart, which requires a procedure for relief. In rare cases, pericarditis may disrupt the heart's activity, which is when surgical treatment may be needed.
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What are the symptoms of pericarditis?
Pericarditis symptoms can vary, but chest pain is often the main symptom. It's usually described as a sharp pain in the center or left side of the chest, which may spread to the shoulder or upper back. The pain can get worse when lying down, coughing, or breathing deeply, and often feels better when sitting up or leaning forward. This pain is caused by the pericardium layers rubbing together, which is why these symptoms are sometimes mistaken for a heart attack. Other symptoms can include a dry cough, fever, heart palpitations, trouble breathing, and fatigue. In rare cases, swelling in the feet, ankles, legs, or abdomen may also occur.
Request an appointment with the heart specialists at Mass General Brigham to learn more about pericarditis diagnosis and treatment options.
What are the types of pericarditis?
Recurrent or chronic pericarditis occurs when someone who previously had acute pericarditis experiences a return of symptoms after being symptom-free for at least four to six weeks.
Incessant pericarditis is when symptoms of pericarditis persist for more than three months without significant improvement or response to treatment.
Constrictive pericarditis occurs when the pericardium becomes thickened and scarred, losing its elasticity. This can lead to symptoms of heart failure. In most cases, constrictive pericarditis develops gradually over time. Some patients may have had a previous episode of acute pericarditis, while others may develop constrictive pericarditis without any prior symptoms.
What causes pericarditis?
Although the exact cause of pericarditis is unknown in most cases, many possible causes exist. The condition often develops after a viral infection, such as a gastrointestinal virus or the COVID-19 virus. Other types of bacterial or fungal infections can also lead to pericarditis.
Other causes of pericarditis could include inflammatory diseases, such as rheumatoid arthritis, or chronic health conditions like cancer or kidney disease. An injury to the chest or the heart can also cause pericarditis. A heart attack, heart surgery, and taking medications such as blood thinners can contribute to developing pericarditis.
What are pericarditis risk factors?
Pericarditis can occur in anyone, but young adults and adult males are more likely to develop the condition.
How is pericarditis diagnosed?
A pericarditis diagnosis often starts with a doctor listening to the heart and chest through a stethoscope during a physical examination. There is a specific sound the doctor is listening for, referred to as a pericardial friction rub. Any recent illnesses, surgeries, or heart problems need to be discussed with the physician, plus any recent symptoms.
Testing often starts with blood tests, which can show the presence of a heart attack, autoimmune disease, or signs of a recent infection. However, other tests may be needed for the diagnosis of pericarditis, such as a chest X-ray or an electrocardiogram (EKG or ECG), which assesses the heart’s rhythm among other things.
In many cases, specialized cardiac imaging is needed to confirm a diagnosis of pericarditis. An ultrasound called an echocardiogram can also be used to see if the heart has fluid around it. A cardiac computerized tomography or CT scan can create images of the heart and measure its thickness. A cardiac MRI scan can show both thickening and inflammation around the heart, which can aid in diagnosing pericarditis.
How is pericarditis treated?
Pericarditis can go away on its own, but often medication is needed for treatment. The medication prescribed depends on the cause of the pericarditis (if known). For instance, bacterial infections would be treated with antibiotics while a fungal infection would be treated with antifungal drugs.
Other medications for managing pericarditis symptoms may include pain relievers like ibuprofen or aspirin, and colchicine, an anti-inflammatory drug. In some cases, stronger medications such as corticosteroids may be necessary.
If fluid builds up around the heart, a procedure may be necessary to drain the fluid.
Nonsurgical treatments for pericarditis
One option for draining excess fluid around the heart due to pericarditis is called a pericardiocentesis. A needle is inserted into the chest and through the pericardium into the space surrounding the heart. Once inserted, a catheter is placed into the pericardium, and the fluid is drained. It is considered a less invasive alternative for draining fluid compared to surgery.
Surgical treatments for pericarditis
Surgery may be required for individuals with chronic fluid buildup or where pericardiocentesis is not an appropriate option. One surgical treatment option is a minimally invasive procedure known as a pericardial window. This is where a small incision is made to remove a portion of the pericardium so that fluid can drain out more easily.
For patients with constrictive pericarditis, a pericardiectomy may be performed. This is a surgery to remove either the entire pericardium or a large portion of it. Although this surgery might not fix the cause of the inflammation, it does allow the heart to function normally again.
Pericarditis prognosis and recovery
Most cases of pericarditis resolve on their own, but complications can arise, especially if left untreated. The most severe complications include recurrent chest pain (affecting up to 30% of patients), life-threatening fluid buildup around the heart (in 3% of patients), and chronic heart failure due to constriction (in 1-2% of patients). Rest is essential for a full recovery, and following the prescribed treatment plan can significantly reduce the risk of pericarditis recurring.
Many patients respond to treatment within a week, but it's important to complete the treatment plan for the length of time prescribed. Recovery from surgery could take even longer, usually several weeks or months.
How to prevent pericarditis
Pericarditis can't be prevented, but measures can be taken to avoid infection or reduce the chance of getting one. Practicing good hygiene, such as frequent hand washing, is highly recommended for both preventing and spreading infection. Staying up to date on COVID-19 and influenza vaccinations is also recommended. Avoiding others with known sicknesses or flu-like illnesses can help you avoid possible infection.
Pericarditis FAQs
Most cases of pericarditis are not life-threatening. However, in rare instances, it can cause a dangerous buildup of fluid around the heart, which may require a procedure to drain the fluid. Over time, some cases of pericarditis can cause the pericardium to lose its elasticity, potentially leading to symptoms of heart failure.
There are many possible causes of pericarditis, but the cause is undetermined in most cases. It often occurs after a viral, bacterial, fungal, or parasitic infection or after heart surgery or a chest injury.
Stress is not a known cause of pericarditis, but it is possible to feel anxious about the diagnosis of pericarditis. It is important to speak to your doctor about any feelings of anxiousness or isolation due to a pericarditis diagnosis.
Yes. Myocarditis is inflammation of the middle layer of the heart, while endocarditis is inflammation of the inner lining of the heart.
