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.Recovery and What Comes After
Pericarditis is inflammation of the sac surrounding the heart, and the chest pain it causes is frightening precisely because it mimics a heart attack. The distinguishing features are usually clear once you know them: the pain is sharp rather than crushing, worse lying flat and better sitting forward, and often worse with a deep breath.
Treatment is longer than most people expect
The instinct is to stop anti-inflammatory treatment once the pain settles, and that is the single most common cause of recurrence. Full-dose NSAID therapy is continued until symptoms and inflammatory markers have normalised, then tapered rather than stopped. Colchicine added for three months substantially reduces recurrence and is now standard, yet it is frequently omitted or abandoned early because patients feel well.
Exercise restriction is part of the treatment
Strenuous activity is restricted until symptoms have resolved and inflammatory markers have normalised — typically several weeks, and considerably longer for competitive athletes. This is not caution for its own sake: exertion during active inflammation is associated with recurrence and, in myopericarditis, with arrhythmia. Returning to the gym as soon as the chest stops hurting is how people end up with a second episode.
Recurrence is common and manageable
Roughly one in five people has a recurrence, most often within the first 18 months, and a smaller group has repeated episodes. That is disheartening but not dangerous in most cases, and it responds to the same treatment with a longer colchicine course. Recurrent disease occasionally warrants immunosuppressive therapy under specialist care.
When chest pain needs emergency assessment
Any new chest pain deserves evaluation rather than self-diagnosis, and this applies even to someone with known pericarditis. Breathlessness, fainting, swelling of the legs and abdomen, or pain with low blood pressure can indicate a pericardial effusion compressing the heart, which is an emergency. Our cardiovascular team manages recurrent and complicated disease, and the coronary artery disease page covers the condition it is most often confused with. The American Heart Association and NHLBI publish patient-level guidance.
What causes it in the first place
Most cases follow a viral infection and no specific organism is ever identified, which frustrates patients wanting a definite answer. Other causes include autoimmune disease, kidney failure, recent cardiac surgery or heart attack, and rarely tuberculosis or malignancy. A search for an underlying cause is worthwhile in recurrent or atypical disease but frequently comes back empty in a first, straightforward episode.
If your chest pain has returned or you are unsure when to resume exercise, schedule a visit.