Do You Have Pericarditis?

As an interventional cardiologist, I frequently see patients dealing with a variety of heart-related issues. One condition that often presents with symptoms mimicking other cardiac ailments is pericarditis. This is an inflammation of the pericardium, the sac-like membrane surrounding the heart. If you or someone you know is experiencing chest pain or discomfort, it's important to understand what pericarditis is, its symptoms, and how it can be treated.

In this post, I will walk you through the key signs and symptoms of pericarditis, the tests cardiologists use to diagnose it, and the available treatments. Whether you're a patient seeking answers or a healthcare professional looking to expand your knowledge, this guide aims to provide clear, actionable information.

What Is Pericarditis?

Pericarditis occurs when the pericardium, the thin membrane around the heart, becomes inflamed. This inflammation can result from infections, autoimmune diseases, injury, or other conditions affecting the heart. In some cases, pericarditis resolves on its own, while in others, it can become chronic or lead to complications that require treatment.

Illustration of a healthy pericardium vs. an inflamed pericardium in pericarditis.

Signs and Symptoms of Pericarditis

The hallmark symptom of pericarditis is sharp, stabbing chest pain that typically worsens when lying down or breathing deeply. However, it can also present in more subtle ways. Here are the common symptoms to watch for:

• Chest Pain

  • Sharp or stabbing pain in the chest that may radiate to the shoulder, neck, or back.

  • Pain worsens with lying flat and eases when sitting up or leaning forward.

• Shortness of Breath

  • Difficulty breathing, especially when lying flat.

• Fever

  • Often associated with infections or inflammation.

• Fatigue and Weakness

  • Feeling unusually tired or run down, even after resting.

• Heart Palpitations

  • An irregular or rapid heartbeat can accompany pericarditis, causing discomfort and anxiety.

• Coughing

  • Dry cough that doesn't seem to resolve, often associated with the irritation of the pericardium.

    
    

If you experience any of these symptoms, it’s important to consult with a cardiologist as soon as possible to rule out other conditions such as a heart attack, pulmonary embolism, or other serious heart diseases.

Causes of Pericarditis

The causes of pericarditis can be diverse and include:

• Viral Infections

  • Common viruses like Coxsackievirus or influenza can trigger inflammation in the pericardium.

• Bacterial Infections

  • More rare, but severe bacterial infections like tuberculosis can lead to pericarditis.

• Autoimmune Diseases

  • Conditions such as rheumatoid arthritis or lupus can cause the body’s immune system to attack the pericardium, leading to inflammation.

• Heart Surgery or Injury

  • Any trauma or recent heart surgery may increase the risk of pericarditis.

• Cancer or Radiation Therapy

  • Certain cancers or treatments for cancer can affect the pericardium.

• Kidney Failure

  • Chronic kidney disease or dialysis patients are at increased risk.

How Is Pericarditis Diagnosed?

Depending on the severity of your symptoms, I may recommend one or more of the following diagnostic tests:

• Physical Examination

  • I will listen to your heart using a stethoscope. A friction rub, which sounds like a grating noise, is often heard in patients with pericarditis. This can help confirm the diagnosis.

• Electrocardiogram (ECG)

  • A 12-lead ECG is crucial for diagnosing pericarditis. Characteristic changes, such as ST elevation in multiple leads, help distinguish pericarditis from a heart attack.

• Echocardiogram

  • An echocardiogram (ultrasound of the heart) allows us to visualize the pericardium and check for fluid accumulation (pericardial effusion). This test is non-invasive and gives real-time images of the heart.

• Blood Tests

  • Blood work, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), helps assess inflammation levels. Elevated markers can confirm the presence of pericarditis.

• Chest X-ray

  • A chest X-ray can help identify fluid buildup around the heart or other potential causes of your symptoms.

• CT Scan or MRI

  • In some cases, I may recommend a CT scan or MRI of the chest to get a more detailed view of the pericardium and identify any complications like pericardial effusion or constrictive pericarditis.

  
  

Treatment for Pericarditis

The treatment for pericarditis depends on the underlying cause, the severity of the symptoms, and whether any complications are present. The goal is to reduce inflammation, manage symptoms, and prevent further damage to the heart.

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

  • Common medications like ibuprofen or indomethacin are typically prescribed to reduce inflammation and alleviate pain.

• Colchicine

  • Colchicine is often used alongside NSAIDs to reduce the recurrence of pericarditis, especially in cases where the inflammation is recurrent.

• Steroids

  • In cases of autoimmune-related pericarditis or when NSAIDs and colchicine are ineffective, corticosteroids like prednisone may be used.

• Antibiotics or Antiviral Medications

  • If pericarditis is caused by a bacterial or viral infection, specific medications may be prescribed. Bacterial pericarditis requires urgent antibiotic therapy, while viral infections may resolve with supportive care.

• Pericardiocentesis

  • If there is significant fluid buildup around the heart (pericardial effusion), a procedure known as pericardiocentesis may be performed to drain the fluid and relieve pressure on the heart.

• Surgical Treatment

  • In severe cases, where there’s ongoing fluid buildup or chronic inflammation (constrictive pericarditis), surgery to remove the pericardium (pericardiectomy) may be required.

Prevention and Outlook

For most patients with pericarditis, the condition improves with proper treatment, and the outlook is generally positive. However, recurrence of pericarditis is possible, particularly in those with viral infections or autoimmune diseases.

To reduce the risk of pericarditis:

• Get vaccinated against influenza and other viral infections.

• Manage chronic conditions such as autoimmune diseases and kidney disease.

• Follow up regularly with your cardiologist if you have had pericarditis in the past.

Conclusion

Pericarditis is a condition that should not be overlooked, as its symptoms can often mimic more serious heart conditions like a heart attack. However, with prompt diagnosis and treatment, most individuals recover fully. If you are experiencing chest pain, shortness of breath, or other symptoms associated with pericarditis, it’s important to consult with a cardiologist for evaluation.

As a cardiologist, my goal is to help patients get the correct diagnosis and find the most effective treatment plan. If you suspect you have pericarditis or have been diagnosed, rest assured that with the right care, you can manage the condition and lead a healthy life.

If you have concerns about pericarditis or any other heart condition, don’t wait—schedule a consultation today. Early diagnosis and management are key to achieving the best outcomes for your heart health. You can contact my office at (813) 280-7300 to book your appointment.