Pericarditis

Pericarditis is inflammation of the protective sac surrounding your heart, causing sharp chest pain that often improves when sitting forward. While it can feel alarming, most people recover within weeks with proper treatment, though some experience recurring episodes that require ongoing care.

Table of contents

• What is pericarditis?
• The protective sac around your heart
• Who gets pericarditis?
• Types of pericarditis
• Signs and symptoms
• What causes pericarditis?
• Risk factors
• How is pericarditis diagnosed?
• Treatment options
• Possible complications
• Living with pericarditis
• Outlook and recovery

What is pericarditis?

Pericarditis is inflammation (swelling and irritation) of the thin sac that surrounds your heart, called the pericardium^[1]. When this protective layer becomes inflamed, its layers can rub against each other or against the heart itself, causing distinctive chest pain^[2].

This condition is the most common disease affecting the pericardium^[3]. While pericarditis can feel frightening, especially because of the chest pain it causes, it is not usually a serious condition^[5]. Most people feel better within a couple of weeks with proper treatment^[8].

• Pericardium
• Heart

The protective sac around your heart

The pericardium is a double-layered sac made of thin tissue that wraps around your heart^[1]. It consists of an inner layer called the visceral layer that sits directly on the heart surface, and an outer parietal layer that forms the protective outer covering^[3].

Between these two layers is a small space that normally contains about 15 to 50 milliliters of fluid^[3]. This fluid acts like a lubricant, helping reduce friction as your heart beats and moves inside the sac. The pericardium holds the heart in place and helps it function properly^[17].

Who gets pericarditis?

Pericarditis can affect anyone at any age^[1]. However, it is most common in males between the ages of 16 and 65^[1]. Another source notes it occurs most often in men aged 20 to 50 years^[2][13].

About 28 people per 100,000 develop this condition each year^[1]. Pericarditis is found in approximately 5% of patients who go to the emergency department with chest pain that is not related to a heart attack^[13].

Types of pericarditis

Doctors classify pericarditis based on how long symptoms last and what causes the inflammation. Understanding these different types helps guide treatment decisions.

Types based on duration

Acute pericarditis develops suddenly and lasts less than four to six weeks^[1][2]. This is often a single episode of symptoms, sometimes called a flare.

Subacute pericarditis describes symptoms that last beyond four to six weeks but go away within three months^[1].

Chronic pericarditis lasts more than three months after the initial episode^[1][7][17].

Recurrent pericarditis occurs when new symptoms appear after at least four to six weeks without symptoms following an initial episode^[1][3][7]. This happens in up to 30% of people who have had pericarditis^[1][3][18].

Types based on cause

Idiopathic pericarditis means the cause is unknown. This is very common, as many cases have no identifiable cause^[1].

Infectious pericarditis is caused by a virus, bacteria, fungus, or parasite^[1]. Viral infections are the most common infectious cause in North America and Western Europe^[1].

Bacterial pericarditis occurs when bacteria enter the pericardium, often from an infected area elsewhere in the body^[6]. It frequently develops in people with pneumonia or those who have had surgery.

Post-myocardial infarction pericarditis can develop after a heart attack. This includes early pericarditis that happens as the body cleans damaged heart tissue, and late pericarditis (called Dressler syndrome) that develops weeks to months after the heart attack^[6].

Traumatic pericarditis develops from an injury to your chest, such as after a car accident^[1].

Uremic pericarditis is caused by kidney failure^[1].

Malignant pericarditis happens when cancer elsewhere in your body affects the pericardium^[1].

Special types

Constrictive pericarditis is a severe form that can develop as a complication of other types. It happens when the pericardium becomes thick, stiff, and scarred, making it harder for the heart to pump blood^[1][6][17].

Chronic effusive pericarditis develops when fluid gradually builds up between the two layers of the pericardium^[6]. Doctors are often unsure about the exact cause, though it may stem from cancer, hepatitis, tuberculosis, low thyroid function, or complications from surgery.

Signs and symptoms

The most common symptom of pericarditis is chest pain^[2][5][7]. This pain is usually sharp and stabbing, though some people experience dull, achy pain or pressure instead^[2][18].

The chest pain is typically felt behind the breastbone or on the left side of the chest^[2][18]. It may spread to your left shoulder, neck, back, or both shoulders^[1][2].

What makes pericarditis pain distinctive is how it changes with position and breathing. The pain often gets worse when you cough, swallow, take a deep breath, or lie flat (especially on your left side)^[1][2][5]. It usually improves when you sit up and lean forward^[1][2][7]. These specific characteristics help doctors distinguish pericarditis from a heart attack^[1].

Other symptoms you may experience include:

• Dry cough^[1][7]
• Trouble breathing when lying down^[1][18]
• Racing or irregular heartbeat, called palpitations^[1][2][7]
• Fatigue or feeling very tired^[1][2][18]
• Low-grade fever or feeling hot and shivery^[1][2][5]
• Feeling sick or light-headed^[5][7]
• Muscle aches and pains^[7]
• Weakness^[7]

In severe cases, you may develop swelling in your legs, feet, ankles, or abdomen (belly)^[1][2][17].

If you have any of these symptoms, especially chest pain, you should contact a doctor right away. Chest pain can be a sign of something serious. If your chest pain is severe, getting worse, or has lasted for 10 minutes, call emergency services immediately^[1][7].

What causes pericarditis?

Pericarditis has many possible causes. However, in many cases, healthcare providers cannot find the exact cause^[1][7]. In North America and Western Europe, the most common causes of acute pericarditis are either unknown (idiopathic) or viral^[1].

Infectious causes

Infections are a common trigger for pericarditis. Viral infections are the most frequent infectious cause in developed countries^[1][7]. Viruses that can cause pericarditis include:

• Influenza (flu)^[1]
• COVID-19^[1]
• Adenoviruses^[1]
• Coxsackie virus A and B^[13]
• HIV (human immunodeficiency virus)^[1]
• Epstein-Barr virus^[13]
• Echovirus^[13]

Bacteria can also cause pericarditis, though this is less common. Bacterial causes include tuberculosis, pneumococcus, staphylococcus, streptococcus, and others^[1][13].

Fungal and parasitic infections are very rare causes^[1][13].

Non-infectious causes

Many cases of pericarditis are not caused by infection. Non-infectious causes include:

• Heart attack^[1][7]
• Surgery or injury to your chest^[1][7]
• Cancer elsewhere in your body^[1][7]
• Autoimmune conditions, such as lupus and rheumatoid arthritis^[1][7][15]
• Kidney failure causing a condition called uremia^[1][7]
• Severe hypothyroidism (underactive thyroid), called myxedema^[1]
• Certain medications^[1][7]
• Radiation therapy to the chest^[1]

Sometimes pericarditis can be caused by certain medicines, including hydralazine and isoniazid^[13]. Pericarditis has also been reported as a rare side effect of some COVID-19 vaccines^[7].

Risk factors

Your risk of developing pericarditis is higher after certain medical events or procedures^[1]:

• A heart attack (this is sometimes called Dressler’s syndrome)^[1]
• Open heart surgery (called postpericardiotomy syndrome)^[1]
• Radiation therapy^[1]
• Other heart treatments, such as cardiac catheterization or radiofrequency ablation^[1]

People with weakened immune systems have a higher risk of developing bacterial pericarditis^[6]. Those undergoing surgery or procedures to drain fluid from the pericardium may also be at increased risk^[6].

How is pericarditis diagnosed?

To diagnose pericarditis, a healthcare professional will examine you and ask questions about your symptoms and medical history^[9]. The doctor will listen to your heart using a stethoscope^[7][9].

Pericarditis creates a specific sound called a pericardial friction rub^[9]. This noise occurs when the two layers of the pericardium rub against each other. A friction rub is found in up to 85% of patients with pericarditis^[13].

Diagnostic tests

Several tests may be used to confirm pericarditis and rule out other conditions that cause similar symptoms:

Blood tests are usually done to check for signs of a heart attack, inflammation, and infection^[9]. Baseline laboratory studies typically include a complete blood count, basic metabolic panel, troponin-I and creatine kinase levels, erythrocyte sedimentation rate, and serum C-reactive protein levels^[13].

Electrocardiogram (ECG or EKG) is a quick and painless test that records the electrical signals in your heart^[9]. Classic changes on the ECG include widespread upward curving ST-segment elevation without reciprocal T-wave inversions or Q waves^[13].

Chest X-ray can show changes in the size and shape of your heart and tell if the heart is enlarged^[9][13].

Echocardiogram uses sound waves to create images of the moving heart^[9]. This test shows how well the heart is pumping blood and can detect any fluid buildup in the tissue surrounding the heart. It can reveal if the pericardium affects how the heart fills with blood or pumps blood^[9]. A transthoracic echocardiogram should be performed in all patients with suspected acute pericarditis to exclude pericardial effusion and cardiac tamponade^[13].

Cardiac CT (computed tomography) scan uses X-rays to create detailed images of the heart and chest^[9]. It can look for heart thickening that may be a sign of constrictive pericarditis.

Cardiac MRI (magnetic resonance imaging) uses magnetic fields and radio waves to create detailed pictures of the heart^[9]. A cardiac MRI can show thickening, inflammation, or other changes in the pericardium.

Pericarditis is usually confirmed with a physical examination and electrocardiogram^[7]. Additional laboratory testing and imaging are determined based on your specific situation and risk factors^[13].

Treatment options

Most cases of pericarditis are mild and improve with treatment^[2][5]. The main goals of treatment are to reduce pain and inflammation, prevent complications, and address any underlying cause.

Rest and activity restrictions

Getting plenty of rest is important during recovery^[22]. You should avoid strenuous exercise or physical activity for a few weeks until your symptoms have gone and your heart is back to normal^[5][22]. Your provider can guide you on how much time you need to rest and when it is safe to resume activities^[5].

Exercise restriction is essential, with patients advised to keep their heart rate below 100 during recovery^[14].

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, are usually the first medicines doctors try^{[6][13][14][18]}. They help bring down swelling and reduce pain. Patients with acute pericarditis should be treated with high-dose NSAIDs^[13][14]. The medication is started at a high dose and then carefully reduced once pain improves and blood tests show less inflammation^[14].

Colchicine is an anti-inflammatory medicine that can be used alone or combined with an NSAID for treating the first episode of acute pericarditis^[13][14]. Colchicine is prescribed for 3 months after a first episode, and for 6 to 12 months if the condition recurs^[14]. The 2025 guidelines from the American College of Cardiology give a strong recommendation for colchicine as part of first-line therapy^[14].

Corticosteroids (steroids), such as prednisone, are used to lower swelling^[6][18]. These are traditionally reserved for severe or refractory cases (cases that don’t respond to other treatments), or when the cause of pericarditis is likely a connective tissue disease, an autoimmune reaction, or uremia^[13]. Steroids should be used carefully, at the lowest effective dose, and reduced very slowly^[14]. This is because stopping steroids too quickly can trigger flare-ups, and long-term use carries risks such as weight gain, high blood sugar, and bone loss^[14].

IL-1 inhibitors are newer medicines that block the body’s process causing repeat flares^[18]. They are used when pericarditis recurs. Until 2021, there were no medications approved by the U.S. Food and Drug Administration specifically to treat recurrent pericarditis. In 2021, the FDA approved the first treatment, called Arcalyst, for managing recurrent pericarditis in people 12 years and older^[15]. This represents an important advance for patients with recurring episodes^[14].

Procedures and surgery

If fluid builds up in the pericardium, a procedure called pericardiocentesis may be needed to drain the fluid^[16]. This can help relieve shortness of breath and improve heart function^[6].

In severe cases, especially with constrictive pericarditis that significantly impacts quality of life, surgery may be necessary^[6][17]. A pericardiectomy is a surgical procedure that removes part or all of the pericardium^[16].

Cardiology consultation is recommended for patients with severe disease, those with pericarditis that doesn’t respond to initial treatment, and those with unclear causes^[13].

Possible complications

While pericarditis is often treatable, it can sometimes lead to more serious problems if not properly managed^[16].

Pericardial effusion occurs when too much fluid builds up in the pericardium^{[1][3][8][17]}. A small effusion may not need treatment, but larger buildups can affect the heart’s ability to pump blood^[8].

Cardiac tamponade (also called pericardial effusion) is a medical emergency^{[1][3][8][15][17]}. This happens when fluid builds up quickly in the pericardial sac, creating sudden pressure on the heart. This increased pressure limits the heart’s ability to fill with blood during the relaxation phase, which can result in a type of shock that requires immediate treatment^[3][8].

Constrictive pericarditis develops when the pericardium becomes thick, stiff, and scarred^{[1][8][15][17]}. This makes it harder for the heart to expand and fill with blood. The condition develops slowly over time^[17]. If medical care is delayed, it can lead to liver damage and heart failure^[6].

In rare cases, people may develop effusive-constrictive pericarditis, which causes both fluid buildup and thickening of the pericardium^[3][17].

Getting diagnosed and treated early can help lower the risk of these long-term complications^[13].

Living with pericarditis

Living with pericarditis, especially recurrent pericarditis, requires careful management and lifestyle adjustments^[15][17].

Following your treatment plan

Taking your medications exactly as prescribed is essential^[22]. Continue to see your cardiologist regularly, especially if you needed surgery or have chronic pericarditis^[22]. These follow-up appointments allow doctors to monitor your heart’s condition closely and detect any changes early^[22].

Managing symptoms and preventing flares

Some people find that positioning tools, like a wedge under the mattress to elevate the upper body, can help lessen chest pain^[18]. Others discover that avoiding certain triggers helps reduce the risk of repeat episodes. Possible triggers may include alcohol, excess heat, stress, or periods of elevated heart rate^[18].

Meditation and breathing exercises, which are known to lower heart rate and stress, may be helpful^[18].

Lifestyle changes for heart health

Making healthier lifestyle choices can support better heart health and help prevent additional complications^[22]. Important steps include:

• Quitting smoking^[22]
• Eating a balanced, heart-healthy diet^[22]
• Managing blood pressure^[22]
• Getting adequate rest^[22]

Treating underlying conditions

If an underlying disease is causing your pericarditis, treating that condition is crucial to prevent symptoms from returning^[16][22]. Underlying conditions that may cause pericarditis include infections, autoimmune disorders like lupus, heart trauma, kidney failure, and cancer^[16][22].

Managing stress and pain

Stress can sometimes worsen symptoms, so finding ways to relax is important^[5]. Try deep breathing, meditation, or gentle yoga. Engaging in activities you enjoy, such as drawing, reading, or spending time with friends, can help distract your mind from stress and pain^[5].

Dealing with the emotional impact

Living with recurrent pericarditis can be challenging because it is unpredictable and can last many years^[15][17]. The pain and uncertainty about when the next flare will occur can make you feel tired and worried^[15]. It might be difficult at times to distinguish a pericarditis episode from other heart or chest problems, which can be stressful^[15]. Flares can lead to hospital stays and emergency department visits^[15].

Remember that you are not alone^[15]. Connect with support groups or talk with your healthcare team about your concerns.

Outlook and recovery

Pericarditis often is mild and may go away without treatment^[2]. When treatment is needed, most people feel better in a couple of weeks^[8]. Although pericarditis can be long-lasting, most people recover within weeks^[5][23].

Acute pericarditis symptoms can last from one to three weeks when properly following after-care instructions^[16]. The condition usually comes on quickly and can last from weeks to several months^[1][11].

Pericarditis by itself carries low mortality (risk of death)^[13]. However, the high rate of recurrence and the difficulty of controlling symptoms can contribute to significant impact on quality of life^[13].

After an initial episode of acute pericarditis, about 30% of patients will have a recurrence within the first year^[13][18]. Treatment for recurrent (chronic) pericarditis can take many years. People with the condition may receive around 4.7 to 6.2 years of treatment with anti-inflammatory medications^[17].

When healthcare professionals find and treat pericarditis early, this helps lower the risk of long-term complications^[2][5][13]. Prompt treatment is key^[1].

With the right treatment plan and careful management, including regular follow-up appointments and adherence to after-care protocols, you can remain proactive about your health and live a long and healthy life after a pericarditis diagnosis^[16][22].