Pericarditis or Acute pericarditis is an inflammation of the pericardium, the thin sac-like membrane that surrounds your heart. This condition can cause chest pain and other symptoms that might be frightening when you first experience them. Understanding pericarditis—what causes it, how it’s diagnosed, and how it’s treated—can help you seek appropriate care and manage your concerns effectively.
What is Pericarditis?
The pericardium consists of two thin layers with a small amount of fluid between them, allowing your heart to beat smoothly. When this protective membrane becomes inflamed, the condition is called pericarditis. The inflammation can cause the layers to rub against each other, leading to chest pain and other symptoms.
Think of the pericardium as a protective sleeve around your heart—when it becomes irritated or swollen, it doesn’t function as smoothly as it should.
Types of Pericarditis
Pericarditis can be categorised based on its development and duration:
- Acute pericarditis: Develops suddenly and typically lasts less than 4-6 weeks
- Recurrent pericarditis: Episodes of pericarditis that return after the initial episode resolves
- Chronic pericarditis: Lasts longer than 3 months, often developing gradually
- Constrictive pericarditis: A rare form where the pericardium becomes thick and rigid, restricting heart function
How Long Does It Take for Pericarditis to Develop?
The onset of pericarditis varies depending on the cause:
- Acute pericarditis can develop suddenly, sometimes within hours after a viral infection or cardiac injury
- Post-cardiac injury pericarditis (following heart surgery or heart attack) typically appears within days to weeks after the cardiac event
- Autoimmune-related pericarditis may develop gradually over weeks as the immune system mistakenly attacks the pericardium
Does pericarditis come on suddenly?
Yes, acute pericarditis often develops suddenly. Many patients report going from feeling normal to experiencing sharp chest pain within hours. The onset of pain in pericarditis is typically rapid, though not instantaneous like a heart attack.
Causes of Pericarditis
Acute pericarditis is most commonly associated with:
- Viral infections (most common cause)
- Coxsackieviruses, echoviruses, influenza, COVID-19
- Herpes viruses, HIV, and others
- Bacteria (less common)
- Tuberculosis, Staphylococcus, Streptococcus
- Post-cardiac injury
- After heart surgery, heart attack, or trauma to the chest
- Radiation therapy to the chest area
- Autoimmune disorders
- Lupus, rheumatoid arthritis, scleroderma
- Inflammatory bowel disease
- Medications
- Certain antibiotics, anti-seizure medications, and chemotherapy drugs
- Other conditions
- Kidney failure, cancer, hypothyroidism
In about 20-30% of cases, the exact cause remains unknown (idiopathic pericarditis).
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Can Stress and Anxiety Cause Pericarditis?
While stress and anxiety can worsen symptoms of existing pericarditis and may trigger recurrences in those with a history of the condition, they are not direct causes of initial pericarditis. However, prolonged stress can weaken your immune system, potentially making you more susceptible to the viral infections that commonly cause pericarditis.
Pericarditis Risk Factors
Factors that may increase your risk of developing pericarditis include:
- Recent viral illness or respiratory infection
- History of heart attack or cardiac surgery
- Autoimmune disorders
- Age and gender (more common in men aged 20-50)
- Previous episodes of pericarditis (increases risk of recurrence)
- Chest trauma
- Certain medications
Symptoms of Pericarditis
The primary symptom of pericarditis is chest pain, which typically:
- Is sharp and stabbing (sometimes described as knife-like)
- Usually occurs on the left side or center of the chest
- May spread to the left shoulder and neck
- Often worsens when lying down, coughing, or taking deep breaths
- Improves when sitting up and leaning forward
Other common symptoms include:
- Mild fever
- Increased heart rate
- Fatigue or weakness
- Cough
- Swelling in the legs or abdomen (in severe cases)
- Shortness of breath, especially when lying down
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What Can Be Mistaken for Pericarditis?
Pericarditis symptoms, particularly chest pain, can be mistaken for other conditions:
- Heart attack – Though heart attack pain is typically more intense and may radiate to the arm or jaw
- Pulmonary embolism – A blood clot in the lungs
- Pneumonia – Infection in the lungs
- Gastroesophageal reflux disease (GERD) – Acid reflux causing chest discomfort
- Costochondritis – Inflammation of cartilage in the chest wall
- Anxiety attacks – Can cause chest tightness and shortness of breath
This is why proper medical evaluation is crucial for accurate diagnosis.
Diagnosis of Pericarditis
If you’re experiencing symptoms of pericarditis, your doctor may recommend:
- Physical examination
- Listening for a “pericardial rub” (friction sound) with a stethoscope
- Electrocardiogram (ECG)
- Shows characteristic changes in electrical patterns of the heart
- Blood tests
- To check for inflammation markers (C-reactive protein, erythrocyte sedimentation rate)
- Cardiac enzymes to rule out heart attack
- Imaging tests
- Echocardiogram: Shows fluid around the heart and pericardial thickening
- Chest X-ray: May show an enlarged heart silhouette if fluid has accumulated
- CT scan or MRI: Provides detailed images of the heart and pericardium
How Long Does Pericarditis Last?
What is the average duration of pericarditis in adults? Most cases of acute pericarditis last about 2-4 weeks with proper treatment. However, the duration varies based on:
- The underlying cause
- How quickly treatment is started
- Individual response to treatment
- Presence of complications
Can pericarditis last for only a few minutes?
No, the symptoms of pericarditis don’t typically resolve within minutes. While the intensity of pain may fluctuate, true pericarditis symptoms persist for hours to days. Brief chest pain that lasts only minutes is more likely due to other causes, such as muscle strain, anxiety, or digestive issues.
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How long can pericarditis go untreated?
Without treatment, acute pericarditis may:
- Resolve spontaneously within weeks (particularly viral cases)
- Persist and become chronic (lasting more than 3 months)
- Lead to serious complications like cardiac tamponade (fluid buildup around the heart) or constrictive pericarditis
Even mild cases should be evaluated by a healthcare provider, as untreated pericarditis can lead to complications.
Treatment Options
Treatment for pericarditis aims to reduce inflammation, relieve pain, and address the underlying cause:
Medications
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Ibuprofen, aspirin, or indomethacin to reduce inflammation and pain
- Often the first line of treatment for uncomplicated cases
Colchicine
- Often combined with NSAIDs to improve recovery and prevent recurrence
Corticosteroids
- For severe cases or when NSAIDs are contraindicated
- Used cautiously as they may increase risk of recurrence
Antibiotics, antifungals, or antivirals
- When a specific infection is identified as the cause
Rest and Lifestyle Changes
- Physical activity restriction during acute phases
- Gradual return to normal activities as symptoms improve
- Heart-healthy diet to support overall cardiovascular health
Hospital Care
In severe cases, hospitalization may be necessary for:
- Monitoring heart function
- Draining excess fluid around the heart (pericardiocentesis)
- Treating complications
Surgical Intervention
Rarely, surgery may be required:
- Pericardiectomy: Removal of part or all of the pericardium (for constrictive pericarditis)
- Pericardial window: Creating an opening to drain fluid
Is Pericarditis Fatal?
Pericarditis itself is rarely fatal with proper treatment. However, if left untreated, serious complications can develop:
- Cardiac tamponade: A life-threatening condition where fluid accumulates around the heart, preventing it from filling properly
- Constrictive pericarditis: When the pericardium becomes scarred and rigid, restricting heart function
- Recurrent pericarditis: Repeated episodes that can affect quality of life
The mortality rate for uncomplicated acute pericarditis is below 1% when appropriately treated. Most patients recover completely without long-term heart damage.
Can Pericarditis Cause High Blood Pressure?
Pericarditis itself typically doesn’t cause high blood pressure. In fact, severe cases that lead to cardiac tamponade may actually cause low blood pressure due to restricted heart function. However:
- Pain and anxiety from pericarditis might temporarily elevate blood pressure
- Some medications used to treat pericarditis, like corticosteroids, can raise blood pressure as a side effect
- If pericarditis affects kidney function (rare), this could indirectly influence blood pressure
Prevention and Management
While not all cases of pericarditis can be prevented, you can:
- Treat infections promptly to prevent complications
- Follow your doctor’s advice regarding medication and follow-up care
- Complete the full course of prescribed medications
- Attend regular check-ups if you’ve had pericarditis before
- Maintain a heart-healthy lifestyle with regular exercise (once recovered), a balanced diet, and stress management
- Avoid smoking and excessive alcohol consumption
When to Seek Emergency Care
Contact your doctor or seek emergency care if you experience:
- Severe, persistent chest pain
- Pain that radiates to your jaw, left arm, or left shoulder
- Difficulty breathing or shortness of breath
- Fever that persists or is very high
- Swelling in the abdomen or legs
- Feeling faint or actual fainting
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Key Takeaways
- Pericarditis is treatable, and most people recover completely with proper care
- Acute pericarditis typically develops quickly and lasts 2-4 weeks with treatment
- The main symptom is chest pain that often worsens when lying down and improves when sitting up and leaning forward
- Viral infections are the most common cause, but many other factors can trigger pericarditis
- Prompt medical attention is important to rule out other serious conditions and prevent complications
- Follow-up care is essential, especially for those with recurrent pericarditis
If you’re experiencing symptoms that could indicate pericarditis, don’t hesitate to consult with a healthcare provider. Early diagnosis and treatment lead to the best outcomes.