Everything You Need to Know About Pericarditis

Pericarditis is a rare heart disease that affects about 100,000 Americans each year.

While pericarditis is relatively rare, recognizing its signs and symptoms is key to determining whether you need medical attention.

If left untreated, pericarditis can cause a variety of serious, life-threatening complications. Knowing when to consult your doctor is essential.

What is Pericarditis?

Pericarditis is a condition that causes inflammation in the pericardium — a sac-like structure with two thin layers of tissue that surrounds the heart.

The pericardium is responsible for helping your heart beat and function properly.

This sac contains a small amount of fluid to keep its two layers apart, reducing friction as the heart beats. Pericarditis can occur when these layers start to rub against each other.

This condition can be acute or chronic. Acute pericarditis tends to develop suddenly and may last for several weeks, while chronic cases may persist for six months or longer.

Symptoms of pericarditis

Symptoms of pericarditis can vary, depending on the type and severity of the condition. The most common symptom is chest pain that:

• Is sharp and located in the center or left side of the chest
• May worsen when lying down or taking deep breaths
• May improve when sitting up or leaning forward
• Can be mistaken for a heart attack

Other symptoms of pericarditis include:

• Shortness of breath, especially when reclining
• Pounding or racing heartbeat (heart palpitations)
• Low-grade fever
• Fatigue
• Persistent, dry cough
• Severe swelling of the legs or abdominal muscle
• A general feeling of being sick

It's crucial to be aware that the symptoms of pericarditis can mimic those of other heart and lung conditions.

If you experience severe chest pain or other symptoms that could be associated with pericarditis, seek immediate medical care.

Early diagnosis and treatment can help manage symptoms effectively and reduce the risk of complications.

Causes of Pericarditis

Viral infections

Viral infections are the most common cause of pericarditis, and they often stem from viruses like:

• Coxsackievirus
• Echovirus
• Influenza
• HIV
• COVID-19

These viruses can directly infect the pericardium or trigger an immune response that causes inflammation of the pericardium.

In most cases, the body’s immune system can deal with the infection and resolve it without needing professional medical care.

However, more severe cases of pericarditis may also develop, potentially leading to health complications if the inflammation is not treated.

Bacterial infection

Although rare, certain strains of bacteria can also infect the pericardium and cause inflammation. These strains include:

• Staphylococcus aureus, which causes skin and soft tissue infections like boils, cellulitis, pneumonia, or bone and joint infections

• Streptococcus pneumoniae, which causes sinusitis, pneumonia, otitis media, septic arthritis, meningitis, and invasive pneumococcal disease

• Mycobacterium tuberculosis, which causes tuberculosis (TB) by attacking the lungs

If not treated, these infections could result in severe pericarditis, potentially causing lasting damage to the heart.

In such cases, emergency medical intervention might be necessary to avoid life-threatening complications.

Autoimmune conditions

Certain autoimmune conditions may affect the pericardium as part of their broader effect on the body. These diseases include:

• Rheumatoid arthritis (RA)
• Systemic lupus erythematosus (SLE)
• Scleroderma
• Progressive systemic sclerosis (PSS)
• Sjörgen’s syndrome
• Polyarthritis

These conditions cause an autoimmune response that triggers the production of antibodies and inflammatory cells that mistakenly attack parts of the body, including the pericardium.

This response causes inflammation that could lead to irreversible damage if the condition is not properly managed.

Post-heart attack pericarditis

If you’ve suffered a heart attack or myocardial injury, pericarditis may develop within weeks or months following the cardiac event.

The cardiac tissue that was damaged during this event triggers an autoimmune response which causes the pericardium to become inflamed.

Other causes

Other causes — like medical procedures, drugs, or diseases — can also cause pericarditis, including:

• Cancer, particularly lung or breast cancer that spreads to the pericardium
• Radiation therapy to the chest
• Certain chemotherapy drugs that cause pericarditis as a side effect, such as cyclophosphamide
• Chronic renal failure, particularly if you’re undergoing dialysis
• Traumatic injury to the chest
• Open heart surgery

Many of these causes trigger an inflammatory response in the chest, which affects the heart. This response can develop days to months after the event.

How is Pericarditis Diagnosed?

Pericarditis should be diagnosed by a medical professional and typically involves a combination of clinical assessments, imaging, and laboratory tests.

These processes help your doctor gain a more comprehensive picture of your condition and the underlying cause that may be responsible for your symptoms.

You can expect the following during your assessment:

• Clinical evaluations are usually the first step to diagnose pericarditis. Your doctor will take your medical history, assess your symptoms, and determine location of the chest pain. They may also listen for a creaking sound — called a pericardial rub — using a stethoscope.

• Electrocardiograms (EKG) or echocardiograms are imaging tests that your doctor may recommend after their evaluation. These tests can record abnormal electrical activity in the heart and identify fluid buildup, both of which can indicate pericarditis.

• Blood tests may also be recommended to detect markers of inflammation — such as C-reactive proteins and erythrocyte sedimentation — and to assess cardiac injuries. These tests can also narrow the causes of pericarditis.

• Pericardiocentesis is a procedure that is performed if fluid accumulation is detected. It involves extracting fluid from the pericardial sac and analyzing it for different organisms.

Each of these processes plays an important role in diagnosing pericarditis and helping your doctor recommend an appropriate treatment strategy.

How is Pericarditis Treated?

Over-the-counter (OTC) medications

The primary treatment for pericarditis is medication that can reduce inflammation and alleviate pain.

This may include OTC nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or — if these drugs are ineffective — medications like colchicine and corticosteroids.

These drugs can be effective in treating the symptoms of pericarditis and preventing recurrent episodes of this condition.

Identifying underlying causes

If pericarditis is caused by bacterial or viral infections, antibiotics are an essential part of treatment.

The duration of the antibiotics course will depend on the severity of your symptoms and your risk of additional complications. Most courses span a period of four to six weeks.

In cases where pericarditis is caused by underlying systemic diseases, your doctor will recommend treatment that focuses on managing that condition.

This approach may involve using a range of medications and implementing certain lifestyle changes.

Medical procedures

If a significant quantity of fluid has accumulated in the pericardial sac, your doctor will recommend procedures to drain the excess from the heart.

If you suffer from recurrent chronic pericarditis, you may need to undergo a pericardiectomy. This procedure involves the removal of parts of all of the pericardium.

Complications and Risk Factors for Pericarditis

While pericarditis is treatable, it can lead to complications if it’s not properly managed. These complications include:

• Cardiac tamponade is a serious complication of constrictive pericarditis that develops when the fluid accumulated in the pericardial sac exerts pressure on the heart. This hinders its ability to pump blood and can be potentially life-threatening.

• Chronic constrictive pericarditis is a condition that causes the pericardium to become thickened and scarred. This can restrict the heart’s normal movement and functioning, which can lead to heart failure.

• Recurrent pericarditis develops when the condition reappears after initial recovery. Recurrent episodes can be frustrating and debilitating, especially if patients experience uncomfortable symptoms that affect their daily lives.

In addition to these complications, several risk factors may increase your chance of developing pericarditis. Common risk factors for pericarditis include:

• Autoimmune disorders
• High blood pressure (hypertension)
• A history of heart surgery or cardiac injury
• Kidney failure or a history of kidney issues
• Cancer — especially if patients are undergoing chemotherapy and radiation
• A history of pericarditis

If you have any of the conditions mentioned above, notify your healthcare provider. This will help them assess your risk and recommend preventive strategies.

When Should You See a Doctor About Pericarditis?

It’s important to seek medical attention as soon as you suspect that you may have pericarditis, especially if you experience symptoms that indicate a serious condition.

Remember that the primary symptom of pericarditis is sharp, persistent chest pain that worsens when you lie down and take a deep breath.

You should also visit your doctor if you experience shortness of breath, fever, a sense of general illness, or heart palpitations.

If you’ve had pericarditis before, monitor any recurring symptoms and consult your doctor if you notice abnormalities.

With conditions like pericarditis, early detection and treatment are key for preventing severe complications and improving your quality of life.

Where Can You Learn More About Pericarditis and Similar Conditions?

If you’re concerned about your heart health and want to know more about pericarditis, LifeMD can help.

LifeMD can connect you to a team of medical professionals who can assist you with information and provide guidance on managing your condition while avoiding further complications.

Make an appointment today to get started.