Pericarditis: Symptoms, Causes & Treatment

Pericarditis is inflammation of the pericardium, the membrane that surrounds the heart. It can cause symptoms such as chest pain that gets worse with deep breathing, shoulder pain, and a persistent cough.

Pericarditis is usually caused by infections, such as colds, the flu, and tuberculosis, or autoimmune diseases, such as lupus and rheumatoid arthritis. However, in many cases, the exact cause cannot be identified.

If pericarditis is suspected, it is important to go to the emergency room for an evaluation. Once the diagnosis is confirmed, treatment may include medications such as anti-inflammatory drugs, colchicine, or antibiotics, and more severe cases may require hospital treatment.

Pericarditis symptoms

The main symptoms of pericarditis include:

• Chest pain

• Shortness of breath

• Heart palpitations

• Fever

• Fatigue

• Persistent cough

• Swelling in the abdomen or legs

Chest pain caused by pericarditis may also affect the upper back, neck, or shoulder. According to the American Heart Association, this pain often gets worse with deep breathing and may improve when sitting up and leaning forward.

Myocarditis vs pericarditis

Myocarditis is inflammation of the myocardium, which is the heart muscle, while pericarditis is inflammation of the pericardium, the membrane that surrounds the outside of the heart.

Both conditions can cause similar symptoms and are usually differentiated with tests such as a chest X-ray, echocardiogram, and electrocardiogram (ECG).

Possible causes

The main causes of pericarditis include:

• Infections caused by microorganisms such as viruses and bacteria

• Autoimmune diseases, such as lupus and rheumatoid arthritis

• Metabolic changes, such as a buildup of urea in the blood

• Chest trauma, which can injure the pericardium

• Heart attack, due to the inflammatory response to damage caused to the heart

• Use of certain medications, such as isoniazid and hydralazine

• Cancer, especially in cases of metastasis

However, in many cases no specific cause of pericarditis is found, particularly when there are no other symptoms (such as fever or shortness of breath) and no history of illness, injury, or recent medication use.

Pericarditis and COVID-19

Although rare, pericarditis can occur as a complication of COVID-19. It is believed to be caused by the body’s strong inflammatory response to the infection and by heart inflammation triggered by the virus.

The risk of pericarditis after COVID-19 vaccination is low, but it has been reported more often in young men and after mRNA COVID-19 vaccines. According to the CDC, clinicians should consider myocarditis and pericarditis in people with acute chest pain, shortness of breath, or palpitations after COVID-19 vaccination, especially adolescents and young adults.

People who develop pericarditis after vaccination often have mild symptoms and recover quickly. Therefore, COVID-19 vaccination continues to be recommended in the US, following CDC and FDA guidance.

Confirming a diagnosis

The diagnosis of pericarditis is made by a cardiologist or primary care provider based on the person’s symptoms and the results of tests such as an ECG and echocardiogram.

The provider may also order other tests, such as a complete blood count (CBC), CT scan, or MRI, to confirm the diagnosis.

Main types

Some of the main types of pericarditis include:

• Acute pericarditis: when pericarditis lasts less than 4 to 6 weeks

• Chronic pericarditis: a form of pericarditis in which inflammation lasts for more than 3 months

• Constrictive pericarditis: when the pericardium loses its ability to stretch, which affects how the heart works

• Viral pericarditis: when pericarditis is caused by a virus

• Bacterial pericarditis: when it is caused by bacteria

• Uremic pericarditis: caused by a buildup of urea in the blood, especially in severe chronic kidney disease

Pericarditis can also be classified as infectious, when it is caused by microorganisms such as viruses and bacteria, or noninfectious, especially when caused by autoimmune diseases or trauma, for example.

Pericarditis treatment

Treatment for pericarditis may include anti-inflammatory medications, such as ibuprofen or naproxen, for up to 2 weeks, and colchicine, which may be prescribed for 3 to 6 months, especially in cases of viral pericarditis or when no specific cause is identified.

Depending on the cause, other treatments may also be recommended, such as antibiotics, diuretics, corticosteroids, chemotherapy drugs, hemodialysis if there is severe kidney function loss, or surgery to remove the pericardium.

In more severe cases of pericarditis, treatment is usually done in the hospital, with medications given directly into a vein.

Potential complications

Complications of pericarditis are more likely in chronic cases or when the condition is not treated correctly. These complications can include constrictive pericarditis and cardiac tamponade, which happens when fluid builds up inside the sac that surrounds the heart.

Complications of pericarditis can be life-threatening, so hospitalization is usually recommended in these cases.