Pericarditis: Symptoms, Causes, Treatments

Medically Reviewed by James Beckerman, MD, FACC on March 31, 2024
14 min read

Pericarditis is inflammation of the pericardium, a thin sac that helps lubricate the heart and protects it from harm. When this double-layered lining gets inflamed, you may have pain or other symptoms when the irritated layers rub against each other. While some symptoms are mild, others can be life-threatening. 

Most of the time, pericarditis happens for unknown reasons. 

Myocarditis is inflammation of the myocardium, or the heart muscle itself. This type of heart inflammation may also cause chest pain, shortness of breath, and dangerous changes in your heartbeat. 

Both conditions can stem from things like an infection or health conditions that boost inflammation in your body. But you’re more likely to have serious and sometimes fatal complications from myocarditis, compared to pericarditis.

Everyone’s experience will be different, but here’s a breakdown of some of the pericarditis symptoms you might have: 

What’s the first sign of pericarditis? 

Sharp chest pain that starts suddenly is usually how it starts. If you’ve ever had a heart attack or know someone who has, you may have similar symptoms. If an infection is the cause of your pericarditis, a fever may pop up around the same time. 

Pericarditis chest pain. Your heart sits behind your breastbone in the front left side of your chest. Pericarditis usually causes a sudden, sharp pain in this area that gets worse with breathing or coughing. 

Pericarditis chest pain may also: 

  • Spread to other nearby spots, such as the top of your left shoulder
  • Ease when you sit up or lean forward
  • Feel dull 
  • Hurt more when you cough, lie down, or take big breaths

Other pericarditis symptoms. Depending on the cause, you may also get: 

  • A cough without mucus or fluid
  • Tiredness or weakness
  • A sick feeling
  • Low fever
  • Increased anxiety 

How long do pericarditis symptoms last?

Most people feel better within 2-6 weeks. But your symptoms may last longer, depending on the type of pericarditis you have and what kind of treatment you need. 

There are different kinds of pericarditis. They’re grouped by how long the inflammation lasts and how your symptoms show up. They include the following: 

Acute (short-term) pericarditis. Your symptoms come on fast and go away within a few weeks. You can have acute pericarditis more than once. Symptoms can mimic a heart attack. 

Chronic pericarditis. Your symptoms and inflammation come on slowly but stick around for longer than 6 months. You may not have sharp chest pain and instead have symptoms such as coughing, trouble breathing, or tiredness. 

Constrictive pericarditis. This is a type of ongoing (chronic) pericarditis. Your pericardium becomes thicker and stiffer than it should be, which makes it harder for your heart to pump blood. If your heart can’t pump blood very well, you may also get swelling in your lower body or belly. You may also have trouble catching your breath, especially after you do something active.Tell your doctor if this happens – you may need treatment right away. But early treatment may help prevent serious problems like heart failure. 

Uremic pericarditis. You can get pericarditis as a complication of advanced kidney disease, or kidney failure. Most people who get this type of pericarditis also have uremia. This is when waste products build up in your blood because your kidneys don’t work well.

Recurrent pericarditis. This is when you get pericarditis again after your symptoms go away for at least a month. Around 15% to 50% of people who get pericarditis once will get it again. 

Incessant pericarditis. You have ongoing symptoms for more than 4-6 weeks but less than 3 months, even though you get treatment. 

Infectious pericarditis. You might get inflammation around your heart when your immune system fights off infections from viruses, bacteria, or other germs. 

Idiopathic pericarditis. This is when you have pericarditis, but your doctor doesn’t know why. (“Idiopathic” is a term used to describe any disease that doesn’t have a clear cause.) 

Traumatic pericarditis. You may get pericarditis if you take a big hit to the chest, such as in a car crash. This is also called post-traumatic pericarditis, and symptoms may show up days or weeks after your injury. 

Malignant pericarditis. People with cancer sometimes get pericarditis. This can happen if you have a tumor directly on your heart or when cancer cells spread from other parts of your body to cause inflammation. 

Most people get this type of swelling for unknown reasons, but it may happen after you get a viral infection. Autoimmune diseases, other medical conditions, and trauma to your heart or chest area may also cause it.

Here are some of the more common causes: 

Infection. Viral infections are the top cause. Illness from things like a cold, the flu, or COVID-19 can trigger an immune response that results in inflammation around your heart. Less often, pericarditis happens after you get sick from bacteria, fungi, or parasites. 

Autoimmune disorders. Conditions that cause inflammation in other parts of your body can affect your heart. These include diseases where your immune system mistakenly attacks healthy tissue, such as:

  • Lupus
  • Rheumatoid arthritis
  • Sjogren’s syndrome
  • Sarcoidosis
  • Scleroderma

Rarely, people with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, can get pericarditis. 

Other medical conditions. This may include health problems that affect your heart or immune system, including: 

  • Recent heart attack
  • Kidney failure 
  • HIV, AIDS, or tuberculosis 
  • Cancer 

Rarely, you may get pericarditis from cancer treatment. This includes radiation therapy around your chest, like the kind commonly used to treat cancers of the breast or lung. 

Surgery or chest trauma. You may get pericarditis days, weeks, or months after a big event like open heart surgery or something else that causes damage to your heart or chest area. For example, injury during a vehicle accident, bike crash, or sports accident might trigger inflammation around your heart. 

Medication. The chemicals in certain drugs that change how your immune system works may lead to inflammation around your heart. 

Can stress cause pericarditis?

Stress alone is unlikely to inflame the sac around your heart. But sudden and serious emotional stress can sometimes weaken your heart muscle, a condition known as broken heart syndrome. Chronic stress may also raise your odds of other health problems that make you more likely to get pericarditis, such as high blood pressure.

Pericarditis can happen to anyone, but certain things raise your odds of getting it. That includes common causes such as infections, a prior heart attack, or chest trauma, along with:

Age and sex. Pericarditis happens most often in young and middle-age adults. This commonly includes people assigned male at birth who are ages 16-65. 

Genetics. Your genes give your body instructions for responding to inflammation. This may be why certain people are more likely to get unexplained pericarditis than others. 

Inherited health conditions. You’re more likely to get pericarditis if you’re born with certain conditions that affect how your body makes inflammation, including rare conditions such as: 

  • Familial Mediterranean fever
  • Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) 

Lifestyle choices. Your heart and immune system may not work as well if you drink too much alcohol or use stimulants such as cocaine, amphetamines, or drugs you put in your body through a vein in your arm. 

How common is pericarditis?

Around 28 people out of 100,000 get pericarditis every year. But if you have one episode, you’re more likely to get this kind of inflammation again.

Your doctor will ask about your symptoms and medical history. Let them know if you have any other recent health problems, including heart trouble or chest injuries, and if you’ve been sick recently. Expect to get a physical exam and some lab tests. 

Expect your doctor to listen to your heart. They may be able to hear something called the pericardial rub. This is a specific sound that happens when the two layers of your pericardium swell and rub together.

Pericarditis EKG

Also known as an ECG, an electrocardiogram is a painless test that shows your doctor the electrical activity in your heart. Certain patterns point toward a pericarditis diagnosis. But you can have pericarditis even if this test is normal. 

Other pericarditis tests

Your doctor may order imaging tests to look inside your body and other lab work, including: 

Chest X-rays to show whether your heart is bigger than it should be or if you have extra fluid around it   

Echocardiography (echo), which uses sound waves to show how well your heart is working and if there’s too much fluid in your pericardium 

Cardiac CT, which takes detailed pictures of your organs and looks for problems around your heart 

Cardiac MRI, a test that uses magnets and radio waves to look at your organs 

Cardiac catheterization to measure the pressure in your heart 

Blood tests to check for signs of a heart attack, high levels of inflammation, or autoimmune diseases

Your treatment depends on what’s causing your pericarditis and how serious your symptoms are, but the main goal is to ease symptoms, lower inflammation, and prevent heart complications. You may need rest, medication, or surgery. 

Colchicine for pericarditis

This is an anti-inflammatory medication. It’s used to treat symptoms that stick around for at least 2 weeks or come back later. It may not be safe to take if you have liver or kidney disease or if you take certain medications. Your doctor will help you decide if colchicine is right for you and how long you should be on it. 

Other pericarditis medications

  • Over-the-counter painkillers like aspirin or ibuprofen 
  • Prescription painkillers if OTC drugs don’t help
  • Steroids to suppress your immune system
  • Antibiotics if you have a bacterial infection
  • Diuretics if you’re retaining too much fluid 

Procedures for pericarditis 

You may need surgery or another procedure to get rid of fluid or tissue from around your heart. This buildup can put pressure on your heart and impair how well it works. 

Surgeries or procedures for pericarditis include:

Pericardiocentesis. Your doctor puts a thin, hollow needle through your chest wall and into the sac around your heart. Through that, they use a tube called a catheter to drain the fluid. 

Pericardiectomy. You may need to have the entire sac around your heart removed. This isn’t usually something you’ll need the first time you get pericarditis. But your doctor might suggest it if you have a type of pericarditis that doesn’t go away and stiffens or thickens your pericardium (chronic constrictive pericarditis).

How fast you’ll get better depends on how serious your symptoms are and the type of pericarditis you have. But with early treatment, most people recover with rest and/or medication within 2-6 weeks. Chronic pericarditis may take longer to go away. 

Your doctor will let you know when it’s safe to return to your normal activities. You may need to skip things like weight training, running, and contact sports for a couple weeks up to 3 months. But you may need to take it easy for longer if you need surgery to treat your inflammation.   

People of all races and ethnicities can get pericarditis, and the symptoms usually look the same in everyone. But compared to some other groups, Black people are more likely to have pericarditis due to kidney failure or other heart problems. 

There are few studies on the differences in pericarditis diagnosis and treatment among racial or ethnic groups. But researchers have found disparities among other heart conditions, such as: 

  • Black and Hispanic people are less likely to have access to health care or to get good treatment for heart disease, compared to White people. 
  • Black people are less likely to get cardiac catheterization for chest pain.
  • Black men and women are more likely to die of heart failure and at a younger age, compared to other races and ethnicities.
  • Black men are the least likely group to get care for heart failure from a heart specialist (cardiologist). 

 People who live in the Black community are also more likely than other racial and ethnic groups to have risk factors for pericarditis, including high blood pressure, diabetes, kidney disease, and heart disease. Autoimmune conditions such as lupus are also more common among Black women than in some other racial groups.

You may not always be able to prevent pericarditis, but there are steps you can take to live well with it, including: 

  • Take the medication your doctor gives you. 
  • Rest until your symptoms go away. 
  • Avoid contact sports or strenuous activity until you fully recover. 
  • Go to follow-up appointments. 

Ask your doctor about any specific lifestyle changes that may help you and your heart. 

How to sleep with pericarditis 

Your heart is on the left side of your body, and you may feel more discomfort if you sleep on this side. You may also have trouble taking full breaths if you lie flat on your back, so consider raising your upper body when you sleep. Put a heating pad or warm compress on your chest to see if that helps you feel better. 

You may not have any serious or long-lasting problems, especially if you get treatment early on. But some complications of pericarditis might include: 

Constrictive pericarditis 

Over time, too much inflammation can thicken your pericardium. If the sac around your heart gets too stiff, your heart may not be able to fill and pump blood to the rest of your body. This isn’t a common complication of pericarditis, but you should tell your doctor if you think you have it.

Signs and symptoms of constrictive pericarditis may include:

  • Swelling in your legs and belly
  • Shortness of breath
  • Tiredness
  • Chest pain
  • Dizziness
  • Feeling full fast
  • Loss of appetite 

Your doctor will ask you some questions and run some tests to find out if you have constrictive pericarditis and to go over the next steps of your treatment, which may include surgery. 

Pericardial effusion

Fluid may build up around your heart when your pericardium is inflamed. This can put pressure on your heart so it can’t fill with blood and pump it back out. 

Cardiac tamponade

Pericardial effusion can put so much pressure on your heart that it can’t fill and empty properly. If this happens quickly, you may not get enough oxygen to the rest of your organs. This is life-threatening and requires medical treatment right away. 

 Pericarditis and COVID

Like other infections, the virus that causes COVID-19 may trigger an overreaction from your immune system that results in too much inflammation around your heart. While the chances this’ll happen are low, people who get COVID-19 are about 35 times more likely to have myocarditis or pericarditis than those who don’t get an infection. 

Your odds of pericarditis also go up if you get long COVID-19 syndrome – when you have lingering symptoms of the illness even though you’ve cleared the virus from your body. This risk seems to be higher in people who already have an autoimmune disease or allergies. 

Less often, the COVID-19 mRNA vaccine may lead to pericarditis or myocarditis. But the chances you’ll get inflammation of the sac around your heart are far lower from the vaccine than if you get the infection. It’s generally recommended that everyone get vaccinated, but talk to your doctor to make an informed decision that’s right for you. 

The outlook for pericarditis is a good one. But you’ll need to check in with your doctor regularly to make sure your treatment is working. Unchecked inflammation can cause serious problems. 

Can pericarditis be cured?

Most people get completely better, but it’s possible for your symptoms to come and go for years, even if they go away for a while. Around 20% to 50% of people who get pericarditis will have repeat episodes of it. Ask your doctor if certain anti-inflammatory drugs or other treatments can lessen the chances this’ll happen to you. 

What to expect with pericarditis 

During recovery, you’ll need a physical exam from your doctor along with bloodwork and medical tests that check for inflammation or other problems with your heart. You may need rest, medication, or other kinds of treatment if your symptoms are serious or don’t get better. 

The chances you’ll have pericarditis complications depend on why you got inflammation in the first place. Your doctor may keep a closer eye on your heart if you had tuberculosis or a bacterial infection or you have cancer or other health conditions. 

There’s no surefire way to prevent pericarditis, especially the first time it happens. But certain healthy habits can protect your heart and the tissue that surrounds it. For starters, you can take steps to avoid getting sick from germs like viruses. 

To prevent infections, you can: 

  • Stay away from people you know are sick from a virus.
  • Wear a mask if you can’t avoid someone with a cold or flu-like symptoms.
  • Wash your hands regularly with soap and water (for at least 20 seconds). 
  • Stay up to date on recommended vaccines. 

Rarely, the COVID-19 vaccine may trigger an immune response that leads to pericarditis or myocarditis. The odds of heart inflammation are much higher if you catch COVID-19, but ask your doctor about the pros and cons of the shot. 

If your pericarditis happened after a heart attack, you can protect your heart if you: 

  • Stop smoking or never start. 
  • Follow a heart-healthy diet low in salt, saturated fat, and added sugars. 
  • Exercise regularly. (Ask your doctor what’s safe for your heart.) 
  • Manage health problems like high cholesterol and high blood pressure. 

If you’ve already had pericarditis, your doctor will let you know what to do to lower the chances you’ll get it again. Some things that they might suggest are: 

  • Get treated for any bacterial infections. 
  • Always wear your seatbelt to lessen chest injury in a crash. 
  • Avoid contact sports or wear chest-protective gear.
  • Get treatment for other health conditions that may lead to pericarditis. 

What makes pericarditis worse? You may have more chest pain when you take deep breaths, swallow, cough, or lie down. Strenuous exercise or physical activity that boosts your heart rate may worsen inflammation or cause discomfort. 

  • Pericarditis is inflammation of the sac that surrounds your heart. This swelling usually goes away without causing serious problems. 
  • You may only need rest and over-the-counter medication to get better. 
  • Rarely, untreated pericarditis can cause serious complications. 
  • You may not be able to tell the difference between pericarditis and a heart attack. Call 911 or go to the hospital if you have serious chest pain. 

Is pericarditis serious? Can it kill you? 

Most cases are mild, but pericarditis can cause serious complications. Excess fluid may stop your heart from working the right way. This can be deadly if you don’t get treatment right away. 

Most people recover in a few weeks without any long-lasting health problems. But you can die from untreated pericarditis if the inflammation puts pressure on your heart or causes other problems that stop your heart from pumping blood and oxygen to the rest of your body. 

What should I avoid if I have pericarditis?

Your doctor will let you know what’s safe, but you’ll probably want to skip contact sports or strenuous physical activity until you’re fully recovered. 

How long do pericarditis flare-ups last?

With rest or medical treatment, a mild episode may start to improve within a few days. Your inflammation may go away completely within 4-6 weeks if you have acute pericarditis. But a full recovery may take a few months or longer if you have chronic pericarditis or need treatment with surgery or another procedure. 

 Is pericarditis an emergency?

Not always. But you should call 911 or get medical help right away if you have signs of pericarditis. This includes symptoms such as chest pain, trouble breathing, or swelling in your belly and lower body. You may not be able to tell the difference between mild pericarditis and something that’s a medical emergency. 

What does pericarditis pain feel like?

You may get a stabbing pain in your chest or a dull ache that feels like it’s crushing your chest. Some people say it feels like a heart attack. 

What triggers pericarditis?

There isn’t always a clear cause, but viral infections are a common cause. You’re also more likely to get pericarditis after a heart attack, heart surgery, or chest trauma from something like a car crash. If you already have pericarditis, strenuous exercise may trigger inflammation.