Pericarditis - Symptoms and causes (2023)



Pericarditis - Symptoms and causes (1)


The heart on the left shows the typical outer lining of the heart (pericardium). The heart on the right shows a swollen and infected lining (pericarditis).

(Video) Pericarditis: Symptoms, Pathophysiology, Causes, Diagnosis and Treatments, Animation

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.


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
  • Get better when sitting up or leaning forward

Other signs and symptoms of pericarditis may include:

  • Cough
  • Fatigue or general feeling of weakness or being sick
  • Leg swelling
  • Low-grade fever
  • Pounding or racing heartbeat (heart palpitations)
  • Shortness of breath when lying down
  • Swelling of the belly (abdomen)

The specific symptoms depend on the type of pericarditis. Pericarditis is grouped into different categories, according to the pattern of symptoms and how long symptoms last.

  • Acute pericarditis begins suddenly but doesn't last longer than three weeks. Future episodes can occur. It may be difficult to tell the difference between acute pericarditis and pain due to a heart attack.
  • Recurrent pericarditis occurs about four to six weeks after an episode of acute pericarditis with no symptoms in between.
  • Incessant pericarditis lasts about four to six weeks but less than three months. The symptoms are continuous.
  • Chronic constrictive pericarditis usually develops slowly and lasts longer than three months.

When to see a doctor

Seek immediate medical care if you develop new symptoms of chest pain.

Many of the symptoms of pericarditis are similar to those of other heart and lung conditions. It's important to be thoroughly evaluated by a health care provider if you have any type of chest pain.

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(Video) Pericarditis (Pericardial Inflammation) Signs & Symptoms (& Why They Occur)

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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


Early diagnosis and treatment of pericarditis usually reduces the risk of complications. Potential complications of pericarditis include:

  • Fluid buildup around the heart (pericardial effusion). The fluid buildup can lead to further heart complications.
  • Thickening and scarring of the heart lining (constrictive pericarditis). Some people with long-term pericarditis develop permanent thickening and scarring of the pericardium. The changes prevent the heart from filling and emptying properly. This unusual complication often leads to severe swelling of the legs and abdomen and shortness of breath.
  • Pressure on the heart due to fluid buildup (cardiac tamponade). This life-threatening condition prevents the heart from filling properly. Less blood leaves the heart, causing a dramatic drop in blood pressure. Cardiac tamponade requires emergency treatment.


There's no specific prevention for pericarditis. However, taking these steps to prevent infections might help reduce the risk of heart inflammation:

  • Avoid people who have a viral or flu-like illness until they've recovered. If you're sick with symptoms of a viral infection, try to avoid exposing others.
  • Follow good hygiene. Regular hand-washing can help prevent spreading illness.
  • Get recommended vaccines. Stay up to date on the recommended vaccines, including those that protect against COVID-19, rubella and influenza — diseases that can cause myocarditis. Rarely, the COVID-19 vaccine can cause inflammation of the outer heart lining (pericarditis) and inflammation of the heart muscle, especially in males ages 12 through 17. Talk to your health care provider about the benefits and risks of vaccines.

Pericarditis care at Mayo Clinic

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(Video) Pericarditis - Overview (signs and symptoms, pathophysiology, diagnosis, treatment)

April 30, 2022

  1. Ferri FF. Pericarditis. In: Ferri's Clinical Advisor 2020. Elsevier; 2020. Accessed April 21, 2020.
  2. Bennett JE, et al., eds. Myocarditis and pericarditis. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Elsevier; 2020. Accessed April 21, 2020.
  3. Melendo-Viu M, et al. A systematic review and meta-analysis of randomized controlled trials evaluating pharmacologic therapies for acute and recurrent pericarditis. Trends in Cardiovascular Medicine. 2022; doi:10.1016/j.tcm.2022.02.001.
  4. What is pericarditis? American Heart Association. Accessed Nov. 30, 2021.
  5. Heart inflammation. National Heart, Lung, and Blood Institute. Accessed Nov. 30, 2021.
  6. Braswell-Pickering EA. Allscripts EPSi. Mayo Clinic. Feb. 10, 2022.
  7. AskMayoExpert. Acute pericarditis. Mayo Clinic; 2020.
  8. Lutschinger LL, et al. Meta-analysis for the value of colchicine for the therapy of pericarditis and of postpericardiotomy syndrome. BMC Cardiovascular Disorders. 2019; doi:10.1186/s12872-019-1190-4.
  9. AskMayoExpert. Constrictive pericarditis. Mayo Clinic; 2020.
  10. Mankad R (expert opinion). Mayo Clinic. Nov. 29, 2021.
  11. Lopez-Jimenez F (expert opinion). Mayo Clinic. Nov. 29, 2021.
  12. Myocarditis and pericarditis after mRNA COVID-19 vaccination. Centers for Disease Control and Prevention. Accessed Nov. 29, 2021.
  13. Mouch SA, et al. Myocarditis following COVID-19 mRNA vaccination. Vaccine. 2021; doi:10.1016/j.vaccine.2021.05.087.
  14. Mevorach D, et al. Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel. The New England Journal of Medicine. 2021; doi:10.1056/NEJMoa2109730.


(Video) Myocarditis (Heart Inflammation) Signs & Symptoms (& Why They Occur)


What causes pericarditis signs and symptoms? ›

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.

What are the most common causes of pericarditis? ›

Causes of pericarditis

The cause of pericarditis is often unknown, though viral infections are a common reason. Pericarditis may occur after a respiratory or digestive system infection. Chronic and recurring pericarditis may be caused by autoimmune disorders such as lupus, scleroderma and rheumatoid arthritis.

What are 4 causes that are most commonly associated with acute pericarditis? ›

Although acute pericarditis is most often associated with viral infection, it may also be caused by many diseases, drugs, invasive cardiothoracic procedures, and chest trauma.

What does the start of pericarditis feel like? ›

A common symptom of acute pericarditis is a sharp, stabbing chest pain, usually coming on quickly. It's often is in the middle or left side of the chest, and there may be pain in one or both shoulders. Sitting up and leaning forward tends to ease the pain, while lying down and breathing deep worsens it.

What helps get rid of pericarditis? ›

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.

How do you make pericarditis go away? ›

You may be given anti-inflammatory painkillers, such as ibuprofen, and you should feel better within 1 to 2 weeks. Sitting up or leaning forward can also help ease the pain.

What makes pericarditis worse? ›

Acute pericarditis is painful inflammation of the pericardium, the fluid-filled pouch surrounding your heart. The pain usually gets worse when you're lying down or when you breathe in.

What foods cause pericarditis? ›

Your provider may recommend a low-salt diet if you have constrictive pericarditis. Avoid saturated fats, alcohol, and sugars, which can increase inflammation and weaken your immune system.

What is the best anti inflammatory for pericarditis? ›

In this setting, however, aspirin is generally the first choice to treat pericarditis, but doses should be increased to reach antiinflammatory effects (from 100 to 300 mg to up to 650 to 1000 mg three times per day).

Can stress bring on pericarditis? ›

Stress cardiomyopathy (CMP) has been described as a complication of post-myocardial infarction pericarditis (Dressler syndrome). Stress CMP can also be complicated by pericarditis. We describe the novel observation where idiopathic pericarditis is the primary disease, which precipitated stress CMP.

What virus causes acute pericarditis? ›

Acute pericarditis (AP), or pericardial sac inflammation, is a self-limited condition in healthy individuals. Viruses, including adenoviruses, enteroviruses, cytomegalovirus, and influenza virus, have been well documented to cause AP.

What are two classic findings of pericarditis? ›

Characteristic clinical findings in pericarditis include pleuritic chest pain and pericardial friction rub on auscultation of the left lower sternal border.

When should you suspect pericarditis? ›

The most common sign of acute pericarditis is chest pain, usually worsened when taking a deep breath. This pleuritic chest pain begins suddenly, is often sharp, and is felt over the front of the chest. Dull, crushing chest pain, similar to that of a heart attack, can also occur.

What is the best test for pericarditis? ›

What tests will be done to diagnose pericarditis?
  • Chest X-ray to see the size of your heart and any fluid in your lungs.
  • Electrocardiogram (ECG or EKG) to look for changes in your heart rhythm. ...
  • Echocardiogram (echo) to see how well your heart is working and check for fluid (a pericardial effusion) around your heart.
Jul 1, 2022

How long does pericarditis usually last? ›

Most people recover in 2 weeks to 3 months. However, pericarditis may come back. This is called recurrent, or chronic, if symptoms or episodes continue. Scarring and thickening of the sac-like covering and the heart muscle may occur when the problem is severe.

Is walking good for pericarditis? ›

Current U.S. guidelines recommend exercise avoidance in individuals during active pericarditis with return to exercise after complete resolution of active disease.

Does pericarditis damage the heart? ›

When treated promptly, most people recover from acute pericarditis in two weeks to three months. It usually leaves no lasting damage to the heart or pericardium.

Is pericarditis caused by Covid? ›

Chest pain in COVID-19 may have cardiac causes, including ACS, pericarditis and myocarditis.

How long does pericarditis take to recover? ›

Pericarditis usually clears up within six weeks and doesn't come back again. While you're recovering, you may need some treatment, depending on what's causing your pericarditis and how bad your symptoms are.

How much rest do you need with pericarditis? ›

The European Association of Preventive Cardiology (EAPC) released recommendations on return to play for athletes in 2019. They recommend against participation in competitive sports during the acute phase of pericarditis and not resuming sports activity for 1 to 3 months after resolution of the active phase.

What foods reduce heart inflammation? ›

The researchers suggested consuming foods with higher levels of antioxidants and fiber to help combat inflammation: Green leafy vegetables (kale, spinach, cabbage, arugula), yellow vegetables (pumpkin, yellow peppers, beans, carrots), whole grains, coffee, tea and wine.

What can flare up pericarditis? ›

In up to 20% of cases, viral illnesses such as herpes, influenza, adenovirus, enterovirus, Epstein Barr virus (EBV), or hepatitis viruses (A, B, C) may also cause recurrent pericarditis. Other potential causes include: Autoimmune conditions such as lupus, scleroderma and rheumatoid arthritis.

Who is most likely to get pericarditis? ›

It mostly affects men ages 20 to 50 years. Pericarditis is often the result of an infection such as: Viral infections that cause a chest cold or pneumonia. Infections with bacteria (less common)

Can dehydration cause pericarditis? ›

The condition is possibly the result of dehydration injury and, in the absence of other obvious causes of pericarditis, is benign.

What can I drink for heart inflammation? ›

4. Hot Tea. Could improving heart health be as easy as sipping on a hot cup of tea each day. Both black and green tea leaves contain polyphenolic compounds known as flavonols and catechins, and research suggests the compounds work to reduce cholesterol production and absorption.

What bacteria causes pericarditis? ›

The most common bacteria that cause this condition are:
  • Haemophilus influenza (also called H. flu)
  • Meningococci.
  • Pneumococci.
  • Staphylococci.
  • Streptococci.
May 6, 2010

What is the first line treatment for pericarditis? ›

Aspirin or NSAIDs are recommended as first-line therapy for acute pericarditis with gastroprotection. Colchicine is recommended as first-line therapy for acute pericarditis as an adjunct to aspirin/NSAID therapy. Serum CRP should be considered to guide the treatment length and assess the response to therapy.

How long do pericarditis flare ups last? ›

You may need to stay in the hospital during treatment so your doctor can check you for complications. Symptoms of acute pericarditis can last from one to three weeks. Chronic pericarditis lasts three months or longer.

Does pericarditis show up on EKG? ›

The electrocardiogram (ECG) is very useful in the diagnosis of acute pericarditis. Characteristic manifestations of acute pericarditis on ECG most commonly include diffuse ST-segment elevation. However, other conditions may have ECG features similar to those of acute pericarditis.

Does pericarditis hurt all the time? ›

The most common symptom of pericarditis is chest pain. This may develop suddenly and be experienced as a sharp, stabbing sensation behind the breastbone on the left side of the body. However, for some people there may be a constant, steady pain, or more of a dull ache or feeling of pressure.

Would pericarditis show up in blood work? ›

The main diagnostic evaluation consists of medical history (recent viral infection) and physical examination (to detect pericardial rubs at auscultation and additional possible signs of a systemic disease that may be responsible for pericarditis); blood tests (WBCs, ESR, CRP, troponin, complete blood count [CBC], urea, ...

What foods should be avoided with pericarditis? ›

Eliminate sources of trans-fatty acids in your diet, such as fast food and processed foods. Avoid refined foods like white breads, white rice, pasta and refined sugar. Avoid coffee, alcohol and tobacco products.

Will a chest xray show pericarditis? ›

Expert Analysis. The chest radiograph (CXR) is typically the first imaging test performed in patients with potential pericardial disease. Within 10 years of the discovery of x-rays, publications highlighted their value in detecting pericardial disease.

Can you live a normal life with pericarditis? ›

Maintaining good health, scheduling regular cardiology appointments, and adhering to after-care instructions can assist patients with living a long and healthy lifestyle after a pericarditis diagnosis.

Is pericarditis long Covid? ›

Acute pericarditis as a major clinical manifestation of long COVID-19 syndrome.

Does pericarditis shorten lifespan? ›

What is the survival rate of pericarditis? Without treatment, the survival rate of constrictive pericarditis is low. After a pericardiectomy, 78% of people can live five years and 57% live another 10 years.

What type of infections cause pericarditis? ›

Pericarditis is often the result of an infection such as:
  • Viral infections that cause a chest cold or pneumonia.
  • Infections with bacteria (less common)
  • Some fungal infections (rare)
Jan 9, 2022

What medications cause pericarditis? ›

One such etiology is drug-induced pericarditis, which is a well-described but relatively uncommon cardiac pathology that can result from a variety of medications. Classically implicated drugs include isoniazid, hydralazine, procainamide, dantrolene, doxorubicin, and penicillin.

Will pericarditis show up on EKG? ›

The electrocardiogram (ECG) is very useful in the diagnosis of acute pericarditis. Characteristic manifestations of acute pericarditis on ECG most commonly include diffuse ST-segment elevation. However, other conditions may have ECG features similar to those of acute pericarditis.

Does pericarditis pain come and go? ›

Pericarditis usually develops suddenly and may last from weeks up to several months. The condition usually clears up after three months, but sometimes attacks can come and go for years.

What can mimic pericarditis? ›

In addition to these conditions, chest pain that can mimic pericarditis is seen in a wide range of conditions including gastric inflammation (gastritis) or ulcers, esophageal inflammation (esophagitis) and gastroesophageal reflux disease (GERD), clots in the arteries of the lung (pulmonary embolism), inflammation of ...

Can you walk with pericarditis? ›

Current U.S. guidelines recommend exercise avoidance in individuals during active pericarditis with return to exercise after complete resolution of active disease.


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