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CardiovascularICD-10: I30.9Accounts for approximately 5% of emergency department visits for chest pain

Pericarditis

Also known as: Pericardial Inflammation, Heart Sac Inflammation, Acute Pericarditis

Pericarditis is inflammation of the pericardium, the thin two-layered sac surrounding the heart, causing sharp chest pain that often worsens with deep breathing, lying flat, or coughing. The condition is most commonly caused by viral infections, but can also result from bacterial infections, autoimmune diseases, heart attack, cardiac surgery, or kidney failure. While most cases of acute pericarditis resolve within a few weeks with anti-inflammatory treatment, some patients develop complications such as pericardial effusion (fluid accumulation) or chronic/recurrent pericarditis.

Symptoms

Sharp, stabbing chest pain, often on the left side or behind the breastbone
Pain that worsens when lying down, coughing, or taking deep breaths
Pain that improves when sitting up and leaning forward
Low-grade fever
Shortness of breath when reclining
General malaise, fatigue, and weakness
Palpitations or rapid heartbeat
Swelling of the legs or abdomen in cases with large pericardial effusion

Causes

  • Viral infections (Coxsackie virus, echovirus, adenovirus, COVID-19)
  • Autoimmune and inflammatory conditions (lupus, rheumatoid arthritis, sarcoidosis)
  • Post-myocardial infarction (Dressler syndrome) or post-cardiac surgery
  • Bacterial, fungal, or tuberculous pericardial infection
  • Uremia (kidney failure) causing metabolic pericarditis
  • Cancer metastasis to the pericardium

Risk Factors

  • Recent viral upper respiratory infection
  • History of heart attack or cardiac surgery
  • Autoimmune or inflammatory conditions
  • Advanced kidney disease requiring dialysis
  • Male sex (more commonly diagnosed in men aged 20-50)
  • Previous episode of pericarditis (risk of recurrence)

Diagnosis

  • Electrocardiogram (ECG) showing characteristic diffuse ST-segment elevation
  • Echocardiogram to detect pericardial effusion and assess heart function
  • Blood tests including inflammatory markers (CRP, ESR), troponin, and CBC
  • Chest X-ray to evaluate heart size and rule out other conditions
  • CT or MRI for complicated or recurrent cases

Treatment

  • NSAIDs (ibuprofen, aspirin) as first-line anti-inflammatory therapy
  • Colchicine to reduce inflammation and prevent recurrence
  • Corticosteroids for NSAID-refractory or autoimmune-related pericarditis
  • Pericardiocentesis (needle drainage) for large or hemodynamically significant effusions
  • Interleukin-1 receptor antagonists (anakinra, rilonacept) for recurrent pericarditis
  • Pericardiectomy (surgical removal of the pericardium) for chronic constrictive pericarditis

Prevention

  • No specific prevention for idiopathic or viral pericarditis
  • Take colchicine as prescribed to prevent recurrence after initial episode
  • Manage underlying autoimmune or inflammatory conditions
  • Avoid vigorous exercise during active pericarditis to prevent complications
  • Follow up regularly with a cardiologist after an episode of pericarditis

When to See a Doctor

  • You experience sharp chest pain, especially with breathing or position changes
  • Chest pain is severe, new, or different from any previous episodes
  • You develop shortness of breath, fever, or leg swelling with chest pain
  • You have had pericarditis before and symptoms are recurring

Frequently Asked Questions

Related Conditions

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Asthma

Respiratory

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Medical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.

Content reviewed against peer-reviewed medical literature and clinical guidelines. Read our editorial standards.