Pericarditis
The heart sits inside a thin two-layered sac called the pericardium. A little fluid between its leaves lets the heart glide with every beat.
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Medicines commonly prescribed for Pericarditis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 500 mgActive substance: mesalazineManufacturer: Faes Farma S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 200 mgActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription requiredDosage form: TABLET, 200 mgActive substance: ibuprofenManufacturer: Nutra Essential Otc S.L.Prescription not required
The heart sits inside a thin two-layered sac called the pericardium. A little fluid between its leaves lets the heart glide with every beat. When that sac becomes inflamed, the leaves turn rough and a sharp chest pain appears that changes with how you sit and how you breathe. Most of the time pericarditis is set off by an ordinary viral infection and settles within a couple of weeks. But chest pain is far too ambiguous to sort out on your own, and pericarditis itself has complications that develop quickly. What follows is how it hurts, how it is confirmed, how it is treated and what should put you on alert.
How the pain behaves
The pain of pericarditis has a recognisable signature, and it is often suspected from that alone, before any test.
- It is sharp, stabbing or knife-like rather than crushing, and usually sits behind the breastbone or slightly to the left.
- It gets worse on a deep breath, on coughing, on swallowing and on lying flat on the back.
- It eases on sitting up and leaning forward. This is the most telling feature: patients often find that position by themselves and sleep propped up.
- It frequently spreads to the left shoulder, to the top of the shoulder or into the trapezius muscle — that echo in the shoulder is close to a calling card of pericarditis.
- It can go on for hours and days, rising and falling, rather than coming in attacks of a few minutes.
Other things usually keep it company: a slight temperature, shivering, weakness, a dry cough, sometimes breathlessness and aching joints, with a faster pulse than usual. One to three weeks earlier many people have had a cold, a stomach bug or simply a spell of feeling unwell.
The exceptions are worth remembering: in older people and in those being treated for kidney failure the picture can be blurred, and breathlessness and weakness come to the front instead.
Why it happens
In most cases the exact cause is never found, and that is a normal outcome of the work-up rather than a failure of it. When a cause is identified, it usually comes from this list:
- Viruses — the commonest finding. The same ones that cause colds, flu or a stomach bug.
- Bacteria — rarer but more serious; pus in the pericardium means treatment in hospital. Tuberculosis stands apart: it produces a slowly building pericarditis with prolonged fever, sweats and weight loss, and it is always considered where tuberculosis is common.
- Heart attack and heart surgery. The pericardium can become inflamed both in the first days after a heart attack and weeks after one, or after an operation on the heart.
- Autoimmune disease — lupus, rheumatoid arthritis and their relatives.
- Severe kidney failure, particularly in people on dialysis.
- Cancer and radiotherapy to the chest.
- Chest injury and certain medicines.
- An underactive thyroid — a rare cause, but an easy one to check and an easy one to correct.
Chest pain that may not be pericarditis at all
This is the central question of the whole page. Chest pain occurs in conditions that kill within hours, and they cannot be told apart without investigation. Call an ambulance — in Spain, Italy, Portugal, Poland and Ukraine the single number is 112 — if the chest pain:
- is crushing or squeezing, as though a slab were lying on the chest, and spreads to the arm, neck, jaw or back;
- comes with cold sweat, nausea, sudden weakness or a sense of impending disaster;
- comes with severe breathlessness, blue lips, fainting or the feeling of about to faint;
- started abruptly and is described as tearing, going through to between the shoulder blades;
- lasts more than fifteen minutes and does not settle with rest.
Behind pain like that may lie a heart attack, a clot in the lung artery, a tear in the aorta or a collapsed lung. While waiting for the ambulance, do not drive yourself. Having been diagnosed with pericarditis already changes nothing: one does not protect you from the other.
There are also less urgent look-alikes, sorted out in the consulting room: pleurisy and pneumonia, heartburn and acid coming up from the stomach, pain in the chest muscles and rib cartilages after exertion or coughing, nerve pain between the ribs, a panic attack. Each has its own logic, and it is the doctor and the tests that separate them, not how it feels.
How the diagnosis is confirmed
The diagnosis is assembled from several findings, none of which settles it alone.
- Listening to the heart. A pericardial rub is sometimes audible — a scratching sound, like skin rubbed against skin. It comes and goes, so the heart is listened to more than once.
- An ECG. In pericarditis it changes in a characteristic way, and differently from a heart attack. It is quick, painless and available everywhere, and it is done first.
- Echocardiogram — an ultrasound scan of the heart. This one is essential: only it shows whether fluid has collected around the heart and how much. Without it, pericarditis is not considered fully investigated.
- Blood tests. Inflammatory markers show how intense the inflammation is, and troponin shows whether the heart muscle has been caught along with the lining. Plus a full blood count, kidney function and thyroid function.
- Chest X-ray — rules out pneumonia and shows an enlarged heart shadow when there is a lot of fluid.
- CT or cardiac MRI — not for everyone, but where the picture is unclear, where scarring is suspected of squeezing the heart, and in repeated episodes.
What brings the inflammation down
The aim of treatment is to put out the inflammation and stop the illness returning. Most people feel distinctly better within days, and it clears completely in two to four weeks.
- Anti-inflammatory painkillers. The backbone of treatment; they are taken as a full course with a gradual reduction guided by blood tests, not simply when it hurts. They irritate the stomach and affect the kidneys, so they are not prescribed with peptic ulcer disease or serious kidney disease, are used cautiously with high blood pressure and heart failure, need to be agreed with a doctor alongside blood-thinning medicines, and are often paired with something to protect the stomach.
- Colchicine. Added to them for several months, it markedly lowers the chance of the illness coming back — one of the few measures with proven benefit. The dose is set by weight and kidney function, and the commonest nuisance is loose stools.
- Steroid tablets. Second line, when the above has not worked or there is an autoimmune cause. They have one feature worth knowing in advance: they must never be stopped on your own. The dose is brought down slowly to the doctor's plan, otherwise the illness returns and the body has no time to restart producing its own hormones. The same applies to breaking off colchicine or the anti-inflammatories before the course is finished.
What else the treatment involves
It does not end with medicines, and the remaining three points weigh just as heavily on the outcome.
- Treating the cause, where one has been found: antibiotics for bacterial inflammation, anti-tuberculosis treatment, control of the underlying kidney, thyroid or autoimmune disease. Without that the pericardium becomes inflamed again and again.
- Rest from exertion. Sport and heavy physical work are postponed until the pain has gone and the blood tests have normalised — and for people who train seriously, for several months. This is not over-caution: exertion on an inflamed heart worsens the course and raises the risk of a return.
- Draining the fluid. Where a large amount has collected, the contents of the pericardium are removed through a needle or a fine catheter under ultrasound guidance. The fluid is sent for analysis at the same time, and sometimes that is what answers the question of cause. Less often surgery is needed: a window in the pericardium, or removal of the scarred lining.
Fluid around the heart, and why it is watched
An inflamed pericardium produces fluid. A small amount is harmless and reabsorbs on its own, but if there is a lot of it and it builds up fast, the sac stops stretching and starts to squeeze the heart. The chambers cannot fill with blood and the circulation drops away. This is cardiac tamponade, a situation counted in minutes, in which the fluid has to be taken off urgently.
Call an ambulance without delay if there is:
- increasing breathlessness that is worse lying down;
- sudden weakness, dizziness, fainting or vision going dark on trying to stand;
- a fast weak pulse, cold clammy skin, blue lips;
- swollen neck veins and a puffy face;
- severe agitation and air hunger while completely at rest.
There is a slow version of the problem too: after long-standing or repeated inflammation the pericardium sometimes scars and turns into a rigid shell. That squeezing builds over months and shows itself not as pain but as breathlessness on exertion, swollen legs, a swelling abdomen and prominent neck veins. Treating it means surgery, and it is worth remembering if strength never came back after an episode of pericarditis.
Recurrence and getting back to normal life
In roughly one in three to one in five people, pericarditis returns — most often within the first months and usually more mildly than the first time. That is precisely why the prescribed course has to be finished rather than dropped as soon as the pain stops: an undertreated first episode is the main reason for a second.
What makes that period easier:
- keep a short diary: when it hurt, in what circumstances, what you took. At the follow-up appointment it saves time and sharpens the dosing;
- go back to exertion gradually and with the doctor's agreement, guided by how you feel and by the blood tests rather than by the calendar;
- do not add painkillers of your own beyond the plan: they belong to the same group as the treatment, and an excess punishes the stomach and kidneys;
- if breathlessness appears that was not there before, get seen without waiting for the scheduled visit;
- remember that tiredness and anxiety after an illness of the heart are ordinary, and they can be raised with a doctor too.
In the great majority of people pericarditis ends in full recovery and leaves no mark on the heart.
Online consultation
New or worsening chest pain is not something to work through online: that situation needs an ECG and an examination, and where the warning signs are present, an ambulance. But everything that surrounds a diagnosis already made is well suited to a conversation from home. A doctor can go through the ECG and echocardiogram reports with you and explain what the inflammatory markers mean and why they are repeated; advise on taking anti-inflammatories if your stomach or kidneys are a problem and what to do about loose stools on colchicine; set out a clear plan for reducing the dose so that treatment is not abandoned early; say when you can go back to running, to the gym and to work. One reason of its own to write in: breathlessness or swelling appearing months after recovery, and repeated episodes of the same pain.
This material is for information only and does not replace medical advice.
Consult with a doctor about Pericarditis
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Pericarditis
Discuss your symptoms and possible next steps for Pericarditis with a doctor online.
