Pericarditis is a condition in which the sac-like covering around the heart (pericardium) becomes inflamed.

The cause of pericarditis is unknown or unproven in many cases. It mostly affects men ages 20 to 50 years.

Pericarditis is often the result of an infection such as:

• Viral infections that cause a chest cold or pneumonia
• Infections with bacteria (less common)
• Some fungal infections (rare)

The condition may be seen with diseases such as:

• Cancer (including leukemia)
• Disorders in which the immune system attacks healthy body tissue by mistake (autoimmune diseases)
• HIV infection and AIDS
• Underactive thyroid gland
• Kidney failure
• Rheumatic fever
• Tuberculosis (TB)

Other causes include:

• Heart attack
• Heart surgery or trauma to the chest, esophagus, or heart
• Certain medicines, such as procainamide, hydralazine, phenytoin, isoniazid, and some drugs used to treat cancer or suppress the immune system
• Swelling or inflammation of the heart muscle (myocarditis)
• Radiation therapy to the chest

Chest pain is almost always present. The pain:

• May be felt in the neck, shoulder, back, or abdomen
• Often increases with deep breathing and lying flat, and may increase with coughing and swallowing
• Can feel sharp and stabbing
• Is often relieved by sitting up and leaning or bending forward

You may have fever, chills, or sweating if the condition is caused by an infection.

Other symptoms may include:

• Ankle, feet, and leg swelling
• Anxiety
• Breathing difficulty when lying down
• Dry cough
• Fatigue

The cause of pericarditis should be identified, if possible.

High doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin are often given with a medicine called colchicine. These medicines will decrease your pain and reduce the swelling or inflammation in the sac around your heart. You will be asked to take them for days to weeks or longer in some cases.

If the cause of pericarditis is an infection:

• Antibiotics will be used for bacterial infections
• Antifungal medicines will be used for fungal pericarditis

Other medicines that may be used are:

• Corticosteroids such as prednisone (in some people)
• "Water pills" (diuretics) to remove excess fluid
• Other anti-inflammatory agents

If the buildup of fluid makes the heart function poorly, treatment may include:

• Draining the fluid from the sac. This procedure, called pericardiocentesis, is done using a needle, which is guided by ultrasound (echocardiography) in most cases.
• Cutting a small hole (window) in the pericardium (subxiphoid pericardiotomy) to allow the infected fluid to drain into the abdominal cavity. This is done by a surgeon.

Surgery called pericardiectomy may be needed if the pericarditis is long-lasting, comes back after treatment, or causes scarring or tightening of the tissue around the heart. The operation involves cutting or removing part of the pericardium.

Pericarditis can range from mild illness that gets better on its own, to a life-threatening condition. Fluid buildup around the heart and poor heart function can complicate the disorder.

The outcome is good if pericarditis is treated right away. Most people recover in 2 weeks to 3 months. However, pericarditis may come back. This is called recurrent, or chronic, if symptoms or episodes continue.

Scarring and thickening of the sac-like covering and the heart muscle may occur when the problem is severe. This is called constrictive pericarditis. It can cause long-term problems similar to those of heart failure.

Contact your provider if you have symptoms of pericarditis. This disorder is not life threatening most of the time. However, it can be very dangerous if not treated.

Many cases cannot be prevented.

Published Date: February 27, 2024
Published By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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