Pericarditis – Symptoms and Causes
Overview
Pericarditis involves inflammation of the pericardium, the protective sac that surrounds the heart. When this thin tissue becomes irritated and swollen, it often causes sharp pain in the chest.
This pain typically occurs when the inflamed layers of the pericardium rub against each other. Many cases of pericarditis are mild and resolve without medical intervention.
For more severe symptoms, doctors may prescribe medications. Surgical procedures are rarely necessary. Early diagnosis and treatment are important as they can help reduce the risk of developing long-term complications.
Signs and Symptoms
Pericarditis commonly causes chest pain that feels sharp or stabbing, though some people may experience it as dull, achy, or pressure-like. This pain typically occurs behind the breastbone or on the left side of the chest.
The pain may spread to the left shoulder and neck, or both shoulders. It also worsens when coughing, lying down, or breathing deeply, but improves when sitting up or leaning forward.
People with pericarditis might also experience:
- Coughing
- Fatigue or general weakness
- Swollen legs or feet
- Mild fever
- Heart palpitations (racing or pounding heartbeat)
- Difficulty breathing when lying down
- Abdominal swelling
Symptoms vary based on the type of pericarditis:
| Type | Characteristics |
|---|---|
| Acute | Sudden onset, lasting less than 4 weeks. May be confused with heart attack pain. |
| Recurrent | Returns about 4-6 weeks after acute episode, with no symptoms between episodes. |
| Incessant | Lasts 4-6 weeks but less than 3 months, with continuous symptoms. |
| Chronic Constrictive | Develops slowly and continues for more than 3 months. |
When to Get Medical Help
Seek immediate medical attention if you experience new chest pain. Many pericarditis symptoms resemble those of other heart and lung conditions, making professional evaluation essential.
Don’t try to diagnose yourself – a healthcare provider needs to examine you to determine the cause of your symptoms and rule out serious problems like heart attacks.
Causes
Pericarditis often has no clear cause, which doctors call idiopathic pericarditis. When causes can be identified, they fall into several categories:
Infection-Related Causes:
- Viral infections (most common infectious cause)
Immune System Reactions:
- Response after heart attack or cardiac surgery (sometimes called post-cardiac injury syndrome)
- Autoimmune conditions like lupus and rheumatoid arthritis
Other Potential Causes:
- Direct injury to the chest or heart
- Chronic health conditions including kidney failure
- Cancer affecting the heart area
- Certain medications, including:
- Seizure medications like phenytoin
- Heart rhythm medications such as procainamide
The body’s inflammatory response to these triggers leads to the swelling and irritation of the pericardium that characterizes this condition.
Complications
Treating pericarditis early can reduce the risk of serious problems. However, several complications may still occur.
Pericardial effusion is the buildup of fluid around the heart. This extra fluid can impact how well the heart works.
Constrictive pericarditis happens when the heart lining becomes thick and scarred. This permanent damage makes it hard for the heart to fill and empty properly. People with this condition often experience:
- Severe swelling in legs and abdomen
- Breathing difficulties
Cardiac tamponade is a life-threatening condition where fluid pressure prevents the heart from filling correctly. This leads to:
- Less blood leaving the heart
- A significant drop in blood pressure
This emergency requires immediate medical attention. Without prompt treatment, cardiac tamponade can be fatal.
Ways to Prevent Pericarditis
While there’s no guaranteed method to prevent pericarditis, several steps can help reduce your risk by preventing infections that may lead to heart inflammation.
Avoid contact with sick individuals. Stay away from people with viral or flu-like illnesses until they recover. If you’re the one who’s sick, take steps to protect others by covering your mouth when coughing or sneezing.
Practice good hygiene habits. Regular handwashing is one of the best defenses against spreading illness. Wash your hands thoroughly with soap and water for at least 20 seconds.
Keep up with vaccinations. Stay current on recommended vaccines, including those for:
- COVID-19
- Influenza (flu)
- Rubella
These vaccines protect against viral diseases that can sometimes cause heart inflammation.
While both pericarditis and myocarditis (inflammation of the heart muscle) can occur together due to viral infections, note that in rare cases, the COVID-19 vaccine has been associated with heart inflammation, especially in males between 12 and 17 years old.
Always discuss the benefits and risks of any vaccine with your healthcare provider.
Be aware of symptoms. Early recognition of pericarditis symptoms can help prevent complications. Watch for:
- Chest pain that may be sharp and worsen when breathing deeply
- Shortness of breath when lying down
- Fatigue
- Swelling in the legs or abdomen
Manage existing conditions. If you have autoimmune disorders or other conditions that increase your risk of pericarditis, work closely with your healthcare team to keep these conditions well-controlled.
Follow medical advice. If you’ve had pericarditis before, follow your doctor’s recommendations to prevent recurrence. This may include taking medications as prescribed and attending follow-up appointments.
Lifestyle considerations. Maintaining a healthy lifestyle with regular exercise, a balanced diet, and stress management may support overall heart health, though these measures haven’t been specifically proven to prevent pericarditis.
