10 Key Symptoms Pericarditis Patients Should be Aware of

Pericarditis is inflammation of the pericardium, the thin protective sac that surrounds the heart. Although it is not discussed as often as some other heart conditions, it can affect many people and may range from mild to serious.

In the United States, an estimated 175,000 cases of pericarditis are diagnosed each year, and the number of cases has been increasing. Some people have mild symptoms that improve with treatment, while others can develop complications that require urgent medical care. Recognizing the warning signs early can help reduce the risk of serious or long-term heart problems.

So, what symptoms should you watch for if you think you may have pericarditis? The signs can differ from one person to another, and some may be confused with symptoms of other conditions.

One of the most common symptoms is sharp chest pain. It can sometimes feel similar to the pain associated with a heart attack. However, pericarditis pain often becomes worse with deep breathing, coughing, or lying down, which can help distinguish it from some other causes of chest discomfort.

As with many health conditions, recognizing symptoms early is important. Pericarditis may cause everything from chest pain and fatigue to breathing difficulties and swelling in the legs. Paying attention to these changes can help you seek medical attention sooner when necessary.

In this article, we’ll look at 10 key symptoms of pericarditis that patients should know. Whether you are concerned about possible symptoms or simply want to understand the condition better, knowing these warning signs can help you make informed decisions about your heart health.

10 Key Symptoms and Warning Signs of Pericarditis

Pain When Changing Position

A major characteristic of pericarditis-related chest pain is that it can change depending on body position. The discomfort commonly becomes worse when lying flat and may improve considerably when sitting upright and leaning forward. Leaning forward can reduce pressure on the pericardium and decrease friction between its inflamed layers.

Pain to Respiratory Variation

Pericarditis pain can become more intense when taking a deep breath or coughing. This type of discomfort is known as pleuritic chest pain. Because the inflamed pericardium can irritate nearby tissues, movement of the chest and diaphragm during breathing may increase the pain.

Pain Radiation

Although the pain usually begins in the chest, it can spread to other parts of the body. It may extend toward the neck, shoulders, especially around the trapezius ridge, back, or left arm. Because this pattern can resemble a heart attack, any new or unexplained chest pain should receive prompt medical evaluation.

Fever and General Malaise

People with acute pericarditis may develop a low-grade fever, often below 101°F (38.3°C). Fever can occur as the body’s response to inflammation or an underlying infection, including a viral infection.

A person may also experience malaise, which means a general feeling of illness or discomfort. Weakness and fatigue can also occur and may feel more intense than would normally be expected from everyday activities.

Shortness of Breath (Dyspnea)

Breathing difficulties are another common complaint associated with pericarditis. This may happen for more than one reason. Sharp pain that increases with deep breathing can cause a person to take shorter, quicker breaths to avoid discomfort, creating a feeling of breathlessness.

Another possible cause is pericardial effusion, which occurs when excess fluid collects inside the pericardial sac. If enough fluid builds up, it can place pressure on the heart and lungs, making breathing more difficult, particularly when lying down. This is known as orthopnea.

Heart Palpitations

Some people with pericarditis may notice that their heart feels as though it is racing, fluttering, pounding, or beating irregularly. These sensations are known as palpitations.

Inflammation around the heart can sometimes affect the heart muscle and contribute to abnormal heart rhythms, including arrhythmias such as atrial fibrillation.

Dry Cough

A continuing dry cough may also occur with pericarditis. Like shortness of breath, this can result from inflammation affecting nearby structures, including the pleura, which is the lining surrounding the lungs, or the phrenic nerve that controls the diaphragm.

Swelling (Edema) and Abdominal Fullness

Swelling in the feet, ankles, or legs, along with a sensation of abdominal bloating or fullness, can be an important warning sign.

This type of edema may indicate that the heart is having difficulty pumping blood effectively because of pressure caused by fluid accumulation or restriction from scarring. As blood backs up in the veins, fluid can move into surrounding tissues and cause noticeable swelling.

Dizziness, Lightheadedness, or Fainting (Syncope)

Dizziness, lightheadedness, or fainting can occur when the brain does not receive enough oxygen-rich blood. In someone with pericarditis, these symptoms can be a serious warning sign of cardiac tamponade.

With cardiac tamponade, excess fluid inside the pericardial sac puts significant pressure on the heart. This can prevent the heart chambers from filling properly, causing blood pressure to fall and reducing blood flow to the brain and other parts of the body.

Pericardial Friction Rub

A pericardial friction rub is not something the patient usually feels. Instead, it is a clinical sign that a healthcare professional may hear with a stethoscope.

It sounds like a high-pitched scratching or grating noise caused by the inflamed layers of the pericardium rubbing against one another. It is considered a classic sign of acute pericarditis, although it may not always be present and can sometimes disappear temporarily.

What is Pericarditis?

Pericarditis is a condition in which the pericardium becomes inflamed. The pericardium is a thin, double-layered, fluid-filled sac that surrounds and protects the heart.

This sac performs several important roles. It helps keep the heart positioned within the chest, provides lubrication so the heart can beat smoothly, and offers protection from infection and excessive expansion. When inflammation develops, these functions can become disrupted and symptoms such as chest pain may appear.

During pericarditis, the inflamed layers can rub against each other and create sharp chest pain. Inflammation can also cause additional fluid to collect in the space surrounding the heart, a condition known as pericardial effusion.

These changes affect the environment around the heart and can interfere with normal heart function. A structure that normally provides protection and flexibility can instead become a source of irritation and, in some cases, restriction.

The process begins when the pericardial layers become inflamed. They can become thicker and rougher, causing the surfaces to rub together whenever the heart beats. This friction is a major reason people with acute pericarditis experience sharp, pleuritic chest pain.

Inflammation may also cause the pericardial cells to produce excess fluid. The fluid collects between the two layers of the pericardium. A small amount may not cause noticeable problems, but increasing fluid levels can raise pressure inside the sac.

When fluid accumulates quickly or reaches a large volume, the pressure can become strong enough to compress the heart. This can especially affect the right side of the heart, preventing the chambers from filling properly between beats.

As a result, the amount of blood pumped throughout the body can decrease. In severe cases, this can progress to cardiac tamponade, a medical emergency that can cause a dangerous drop in blood pressure, shock, and death without prompt treatment to remove the excess fluid.

Is Pericarditis a Serious Condition?

Pericarditis can range from mild to serious, depending on the individual case. Many cases of acute pericarditis are relatively mild and may be linked to viral infections. Some improve on their own or with appropriate anti-inflammatory treatment.

Even so, pericarditis should be medically evaluated and monitored because it can sometimes cause serious, potentially life-threatening complications, especially when it is untreated or becomes chronic.

One of the most immediate complications is cardiac tamponade. This occurs when a large amount of fluid, or fluid that accumulates rapidly, places pressure on the heart and prevents it from filling and pumping blood normally.

Possible symptoms include severe shortness of breath, dizziness, low blood pressure, and a weak but rapid pulse. Cardiac tamponade requires urgent treatment, which may include pericardiocentesis to drain the fluid surrounding the heart.

Another serious complication is constrictive pericarditis. After repeated or severe inflammation, the pericardium can become thick, scarred, and less flexible.

The stiffened sac can surround the heart and prevent it from expanding fully to receive blood. This can produce heart-failure-like symptoms such as significant swelling in the legs and abdomen, fatigue, and shortness of breath. In severe cases, treatment may involve surgery to remove the affected pericardium, known as a pericardiectomy.

Pericarditis can also return in some people. Recurrent episodes may occur weeks or months after the original episode. Although recurrence is not always immediately life-threatening, it can interfere with daily life and may require ongoing treatment and monitoring.

What Are Common Causes of Pericarditis?

The most common causes of acute pericarditis include cases where no specific cause is identified and viral infections. It can also develop following damage to the heart from a heart attack or after cardiac surgery.

In North America and Western Europe, the cause cannot be identified in up to 85% of cases. These cases are classified as idiopathic pericarditis, although some may actually be related to viral infections that were never specifically identified.

Idiopathic and Viral Pericarditis

A number of viruses have been associated with pericarditis. Coxsackieviruses and echoviruses are among the viruses commonly linked to the condition. Other possible causes include influenza, Epstein-Barr virus, cytomegalovirus (CMV), and HIV.

The virus may directly affect the pericardial tissue, or the body’s immune response to an infection may trigger inflammation. Because identifying the exact virus is often unnecessary or difficult, many cases are ultimately classified as idiopathic.

Post-Myocardial Infarction (Heart Attack)

Pericarditis can develop after a heart attack in two different ways. Early-onset pericarditis can appear within several days and may result from inflammation spreading from damaged heart muscle to the nearby pericardium.

A delayed form called Dressler’s syndrome can develop weeks or months later. It is thought to involve an autoimmune reaction in which the immune system responds to proteins released by damaged heart tissue. This can cause inflammation of the pericardium and sometimes the pleura.

Post-Cardiac Surgery or Trauma

Surgery or an injury involving the chest can irritate or damage the pericardium and trigger inflammation. This can happen after open-heart surgery, a condition sometimes called post-pericardiotomy syndrome, or after significant blunt or penetrating trauma to the chest.

Similar to Dressler’s syndrome, the inflammation following an injury may involve an immune response to the damaged tissue.

Autoimmune Disorders

Autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, and scleroderma can affect the pericardium. In these conditions, the immune system mistakenly attacks healthy tissues in the body.

The resulting inflammation can become chronic or recurrent. In some cases, pericarditis may even be one of the first signs of an autoimmune condition that has not yet been diagnosed.

Kidney Failure (Uremia)

People with advanced chronic kidney disease or end-stage renal disease can develop uremic pericarditis. This happens when waste products, including urea, build up to high levels in the bloodstream.

These substances can irritate the body’s serous membranes, including the pericardium, and cause significant inflammation.

Cancer (Malignancy)

Cancer can affect the pericardium in several ways. Cancer cells from nearby tumors, such as lung or breast cancer, or cancers that begin elsewhere, such as lymphoma or leukemia, can spread to the pericardium.

This spread can cause inflammation and may lead to a large or bloody pericardial effusion.

Cancer treatment can also affect the pericardium. Radiation therapy directed at cancers in the chest can damage the pericardium and lead to radiation-induced pericarditis, which may develop months or even years after treatment.

Bacterial Infections

Bacterial pericarditis is less common than viral pericarditis in developed countries, but it can be a very serious condition.

Bacteria such as Staphylococcus, Streptococcus, and Pneumococcus can infect the pericardium and cause pus to collect within the pericardial space. This is called purulent pericarditis. Tuberculosis is another important infectious cause, particularly in developing countries.

When to Seek Medical Help?

Chest pain associated with possible pericarditis should always be taken seriously until a healthcare professional has ruled out a heart attack or another dangerous condition.

Pericarditis and acute myocardial infarction can produce very similar symptoms, and it is not possible to reliably distinguish between them at home. Both may cause central chest pain that spreads to the arm or neck, breathing difficulties, and feelings of anxiety.

If you develop sudden, unexplained chest pain, call 911 or your local emergency number immediately. Do not try to drive yourself to the hospital. Emergency medical personnel can begin assessment and treatment while transporting you, which may be especially important if the problem turns out to be a heart attack or cardiac tamponade.

The need for urgent care is even greater when chest pain occurs with severe shortness of breath, dizziness, fainting, heavy sweating, nausea, or intense pressure or crushing discomfort. These symptoms can occur during a heart attack but may also accompany serious complications of pericarditis.

At the emergency department, healthcare professionals may use an electrocardiogram (ECG) and blood tests for cardiac enzymes such as troponin to help distinguish pericarditis from a heart attack.

An ECG in pericarditis may show widespread changes that differ from the more localized changes commonly associated with a heart attack. An echocardiogram can also help identify inflammation and fluid around the heart.

Initial Treatments For Pericarditis

Treatment for uncomplicated acute pericarditis generally focuses on controlling pain and reducing inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine are commonly used as the main treatments.

The aim is to resolve the current episode while also lowering the chance of recurrence or chronic inflammation. If an underlying cause is identified, treating that cause is also an important part of care.

High-dose nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as first-line therapy. Doctors may prescribe medications such as ibuprofen or aspirin at appropriate doses based on the patient’s circumstances.

These medications reduce the production of prostaglandins, substances involved in inflammation and pain. Treatment is generally continued until symptoms and inflammatory markers, such as C-reactive protein, improve, after which the medication may be gradually reduced.

Colchicine, a medication traditionally used for gout, is also commonly included in pericarditis treatment. It works against inflammatory processes involved in the condition.

Research has found that combining colchicine with NSAID treatment can shorten symptoms and significantly lower the risk of recurrent pericarditis. It is often prescribed for several months after an initial episode, depending on the treatment plan.

Steroids such as prednisone are generally reserved for situations where NSAIDs or colchicine cannot be used or have not provided adequate control. They may also be appropriate when an autoimmune condition is responsible for the pericarditis.

Doctors often avoid routine steroid use in viral or idiopathic cases when other treatments are suitable because steroids can increase the risk of recurrence and have additional potential side effects.

Pericarditis Diagnosis

Diagnosing pericarditis usually involves several steps, beginning with a detailed medical history and physical examination. During the examination, a doctor may listen to the heart with a stethoscope for a pericardial friction rub, a characteristic scratchy sound caused by the inflamed pericardial layers rubbing together.

Additional tests can then help confirm the diagnosis and determine whether the heart has been affected. An electrocardiogram (ECG or EKG) is an important diagnostic test and may show widespread ST-segment elevation or other electrical changes associated with pericardial inflammation.

An echocardiogram can provide an image of the heart and help identify inflammation or, more importantly, detect excess fluid around the heart, known as a pericardial effusion.

A chest X-ray may also be performed. In some cases, an enlarged heart silhouette can suggest the presence of a substantial pericardial effusion.

Blood tests can measure inflammation markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which may be elevated. Troponin levels may also be checked because heart-muscle inflammation can occur alongside pericarditis and because the results can help distinguish it from a heart attack.

Types of Pericarditis

Pericarditis can be divided into several types according to how long symptoms continue and whether they return. Understanding the type can help guide treatment and provide information about the expected course of the condition.

Acute pericarditis is the most common type. Symptoms appear suddenly and generally last less than four to six weeks. Chest pain is often sharp and pleuritic and may improve when sitting upright and leaning forward. Many acute cases have no identified cause or are believed to be related to viral infections and improve with anti-inflammatory treatment.

Recurrent pericarditis occurs when symptoms return after a symptom-free period of at least four to six weeks following the original episode. Recurrences can be difficult for patients and may require longer or more intensive treatment, sometimes including medications such as colchicine or corticosteroids.

Incessant pericarditis refers to symptoms that continue for more than four to six weeks but less than three months without a symptom-free period. Persistent inflammation may lead doctors to investigate possible underlying causes, including autoimmune disorders, and may require stronger anti-inflammatory treatment.

Chronic pericarditis is generally used when symptoms continue for more than three months. It can be associated with complications, including chronic constrictive pericarditis. In this condition, prolonged inflammation causes the pericardium to become thick, scarred, and sometimes calcified, making it difficult for the heart to fill normally.

Pericarditis vs. Heart Attack (Myocardial Infarction)

Both pericarditis and a heart attack can cause significant chest pain, but certain characteristics of the pain and other symptoms may differ. Because both conditions can be serious, prompt medical assessment is important.

A heart attack, or myocardial infarction, occurs when blood flow to part of the heart muscle becomes blocked, causing damage to the tissue. Pericarditis, in contrast, involves inflammation of the protective sac surrounding the heart.

Pericarditis usually produces sharp or stabbing chest pain that may become worse with deep breathing, coughing, or swallowing. Heart attack pain is more commonly described as pressure, squeezing, heaviness, or crushing discomfort in the center of the chest.

Another characteristic of pericarditis is that the pain often changes with position. It may improve when a person sits up and leans forward and become worse when lying flat. Heart attack pain is generally less affected by posture or breathing.

Both conditions can cause pain that spreads to other areas, but the patterns can differ. Pericarditis may cause discomfort around the trapezius ridge, extending from the neck toward the shoulder. Heart attack pain more commonly spreads to the left arm, jaw, neck, or back.

Pericarditis may also follow a viral-like illness and can be associated with low-grade fever, fatigue, and malaise. Heart attacks can cause symptoms such as shortness of breath, sweating, and nausea, while fever is not generally a typical early symptom.

Complications of Pericarditis

Although many people recover from pericarditis without lasting problems, the condition can sometimes cause serious complications that require urgent treatment. Two major complications are cardiac tamponade and chronic constrictive pericarditis. Both interfere with normal heart function but develop in different ways.

Cardiac tamponade is an emergency that occurs when a large amount of fluid builds up rapidly or accumulates in significant quantities inside the pericardial sac. The pressure created by the fluid can prevent the heart chambers from filling normally.

As the heart becomes unable to pump enough oxygen-rich blood to the body, blood pressure can fall dramatically. Without prompt treatment, this can lead to shock and potentially death.

Classic signs of cardiac tamponade may include low blood pressure, enlarged neck veins, and muffled heart sounds. Treatment may involve pericardiocentesis, a procedure that uses a needle to drain the excess fluid and reduce pressure around the heart.

Chronic constrictive pericarditis is another major complication. It develops when prolonged or repeated inflammation causes the pericardium to become thick, scarred, and rigid.

The stiffened pericardium can surround the heart and restrict its ability to expand and fill with blood between beats.

This can result in symptoms similar to heart failure, including significant swelling in the legs, fluid accumulation in the abdomen known as ascites, and shortness of breath. A definitive treatment in severe cases may be pericardiectomy, a surgical procedure that removes the stiffened pericardium.

FAQs

1. Can you recover from pericarditis?

Yes, many people recover completely from pericarditis, particularly when the condition is recognized and treated promptly. Acute pericarditis is the most common type and often improves with appropriate medication, rest, and anti-inflammatory treatment.

Recovery can vary depending on the severity of the condition and its underlying cause. Chronic pericarditis can require longer-term management and ongoing medical care. Following your healthcare provider’s treatment recommendations is important for recovery.

2. Is pericarditis life-threatening?

Pericarditis is not usually life-threatening by itself, but complications can become dangerous if the condition is not treated or monitored appropriately. One major complication is cardiac tamponade, in which fluid around the heart places pressure on it and interferes with normal pumping.

Cardiac tamponade can be life-threatening and requires immediate medical attention. Chronic pericarditis can also contribute to lasting heart problems. Early diagnosis and appropriate treatment can help reduce the risk of severe complications.

3. What are the 4 criteria for pericarditis?

The four main diagnostic criteria for pericarditis are:

• Chest pain: Usually sharp and pleuritic, becoming worse with deep breathing or lying down.
• Pericardial friction rub: A distinctive sound heard through a stethoscope that results from inflammation of the pericardium.
• Electrocardiogram (ECG) changes: Characteristic ECG changes, including ST elevation, may occur with pericarditis.
• Pericardial effusion: Fluid buildup in the pericardial space that can be detected through imaging such as an ultrasound.

4. What foods trigger pericarditis?

There are no specific foods known to directly trigger pericarditis, but maintaining a healthy, anti-inflammatory eating pattern may support overall health. Foods high in saturated fats, added sugar, and heavily processed ingredients may contribute to inflammation.

A balanced diet containing fruits, vegetables, whole grains, and sources of omega-3 fatty acids can be part of a healthy approach.

5. How long until pericarditis goes away?

How long pericarditis lasts depends on whether the condition is acute or chronic. Acute pericarditis may improve within several weeks or a few months with appropriate treatment.

Chronic pericarditis can continue for much longer and may require ongoing treatment and monitoring. Many people with acute pericarditis recover fully, while chronic cases may need continued medical care.

6. What not to do with pericarditis?

People with pericarditis are generally advised to avoid activities that may increase inflammation or put unnecessary strain on the heart. This can include strenuous exercise, heavy lifting, or activities that significantly increase the heart rate.

Lying down immediately after eating may also make some symptoms worse. It is also important not to stop or skip prescribed medications without discussing it with your healthcare provider, as doing so may delay recovery or increase the risk of complications.

Conclusion

Pericarditis affects the pericardium, the protective sac surrounding the heart, and can cause a range of symptoms and complications. Although many cases are manageable, recognizing the warning signs early is important for receiving appropriate medical care.

With timely treatment, many people with acute pericarditis recover fully, while chronic forms may require longer-term management. Understanding the symptoms and following your healthcare provider’s recommendations can help support recovery and reduce the risk of complications.

If you experience symptoms that could indicate pericarditis, especially sudden or unexplained chest pain, seek medical attention promptly. Early evaluation and treatment can play an important role in protecting your heart health.