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Pericarditis

Pericarditis is inflammation of the sac surrounding the heart, causing sharp chest pain that often eases when sitting up and leaning forward. Most cases are viral and improve with anti-inflammatory treatment.

Cardiovascular
Pericarditis is inflammation of the pericardium, the thin two-layered sac that surrounds and protects the heart. It most often affects otherwise healthy adults and usually improves with medication, but because its chest pain can mimic a heart attack, it always deserves prompt evaluation. Most cases are acute and resolve within weeks, though some people have recurrent episodes. Causes: In many cases no definite cause is found, and a viral infection is presumed. Known causes include:
  • Viral infections: The most common identifiable trigger, often following a respiratory or stomach virus.
  • After a heart attack or heart surgery: Inflammation can develop days to weeks later.
  • Autoimmune disease: Conditions such as lupus and rheumatoid arthritis can inflame the pericardium.
  • Kidney failure, cancer, radiation, and certain medications: Less common causes that your doctor will consider.
Symptoms: The hallmark is chest pain with distinctive features:
  • Sharp, stabbing pain behind the breastbone: Often spreading to the left shoulder or neck.
  • Pain that changes with position: Typically worse when lying flat or breathing deeply, and better when sitting up and leaning forward.
  • Low-grade fever, fatigue, and a dry cough: Reflecting the underlying inflammation.
  • Palpitations: Some people notice a racing or fluttering heartbeat; rhythm problems such as atrial fibrillation occasionally accompany pericarditis.
Diagnosis: Your doctor may hear a characteristic scratching sound called a friction rub with a stethoscope. An electrocardiogram often shows a typical pattern of widespread changes that helps distinguish pericarditis from a heart attack caused by coronary artery disease. Blood tests measure inflammation and check for heart-muscle injury, and an echocardiogram looks for fluid collecting around the heart, called a pericardial effusion. Treatment: Most pericarditis responds well to medication and rest.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): High-dose ibuprofen or aspirin, tapered over several weeks, relieves pain and inflammation.
  • Colchicine: Added to NSAIDs, colchicine speeds recovery and substantially reduces the chance of recurrence; it is usually continued for three months.
  • Activity restriction: Strenuous exercise is avoided until symptoms and inflammation resolve.
  • Corticosteroids: Reserved for cases that fail other treatment or are caused by autoimmune disease, since steroids can increase recurrences.
Recurrence and Recovery: Roughly one in five to one in three people has at least one recurrence, usually within the first eighteen months. Recurrent episodes are treated the same way, often with a longer course of colchicine, and newer targeted therapies are available through cardiology for the small number of people with frequent, difficult recurrences. Finishing the full tapering course of medication — rather than stopping when pain resolves — is one of the most important things you can do to prevent a relapse. Most people return to normal activity, including exercise, once symptoms and blood markers of inflammation have normalized. When to Seek Immediate Care: Go to the emergency department for chest pain that is severe or crushing, spreads to the arm or jaw, or comes with shortness of breath, lightheadedness, or fainting. A large effusion can compress the heart — a condition called cardiac tamponade — which causes breathlessness and low blood pressure and requires urgent drainage. Rarely, long-standing inflammation stiffens the pericardium and impairs filling of the heart, mimicking valve disease or heart failure. Most people recover fully, but follow-up confirms the inflammation has settled. The internal-medicine team at Zimmer Medical Group evaluates chest pain and coordinates cardiology care when needed — schedule a visit if you have symptoms that concern you.

Related Medications

Commonly prescribed medications for this condition

ColchicineIbuprofen

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