Pericarditis

Pericarditis is swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium). Pericarditis often causes sharp chest pain. The chest pain occurs when the irritated layers of the pericardium rub against each other.

Pericarditis is usually mild and goes away without treatment. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help reduce the risk of long-term complications from pericarditis.

## Symptoms

Chest pain is the most common symptom of pericarditis. It usually feels sharp or stabbing. However, some people have dull, achy or pressure-like chest pain. Pericarditis pain usually occurs behind the breastbone or on the left side of the chest. The pain may spread to the left shoulder and neck, get worse when coughing, lying down or taking a deep breath, or get better when sitting up or leaning forward.

Other signs and symptoms of pericarditis may include:

* Fever and chills
* Cough
* Sneezing
* Sweating
* Nausea and vomiting
* Loss of appetite
* Swelling of the abdomen
* Dizziness, lightheadedness, or vertigo
* Fatigue and weakness
* Tiredness
* Heart palpations
* Shortness of breath
* Arrhythmias
* Fainting
* Loss of consciousness

## Causes

The cause of pericarditis is often hard to determine. A cause may not be found (idiopathic pericarditis).

Pericarditis causes can include:

* Immune system response after heart damage due to a heart attack or heart surgery (Dressler syndrome, also called postmyocardial infarction syndrome or postcardiac injury syndrome)
* Infection, such as COVID-19
* Inflammatory disorders, including lupus and rheumatoid arthritis
* Injury to the heart or chest
* Other chronic health conditions, including kidney failure and cancer

## Rarity

**Pericarditis** is an **uncommon** cause of chest pain. About 3 per 10,000 people are affected per year. Those most commonly affected are males between the ages of 20 and 50.

## Treatment

Treatment for pericarditis depends on the cause and the severity of the symptoms. Mild pericarditis may get better without treatment.

### Medications

Medications to reduce the inflammation and swelling are often prescribed. Examples include:

* **Pain relievers.** Pericarditis pain can usually be treated with over-the-counter pain relievers, such as aspirin or ibuprofen (Advil, Motrin IB, others). Prescription-strength pain relievers also may be used.
* **Colchicine (Colcrys, Mitigare).** This drug reduces inflammation in the body. It's used to treat acute pericarditis or if symptoms tend to come back. You should not take this drug if you have liver or kidney disease. Colchicine can also interfere with other drugs. Your health care provider will carefully check your health history before prescribing colchicine.
* **Corticosteroids.** Corticosteroids are strong medications that fight inflammation. A corticosteroid such as prednisone may be prescribed if pericarditis symptoms don't get better with other medications, or if symptoms keep returning.

If pericarditis is caused by a bacterial infection, treatment may include antibiotics and drainage, if necessary.

### Surgeries or other procedures

If pericarditis causes fluid buildup around the heart, a surgery or other procedure may be needed to drain the fluid.

Surgeries or other procedures to treat pericarditis include:

* **Pericardiocentesis.** In this procedure, a sterile needle or a small tube (catheter) is used to remove and drain the excess fluid from the pericardial cavity.
* **Removal of the pericardium (pericardiectomy).** The entire pericardium may need to be removed if the sac surrounding the heart is permanently rigid due to constrictive pericarditis.