Acute Pericarditis: Causes, Symptoms, and Treatment

Fact checked by Olga Sadouskaya, MD
Clinical Pharmacologist, Chief Medical Officer

Acute pericarditis is inflammation of the pericardium, the flexible, two-layered sac that surrounds the heart, and it can be quite painful. It causes the pericardial space to fill with fluid and blood components, including fibrin, red blood cells, and white blood cells.

Keep reading to find out the signs and symptoms that accompany a diagnosis of acute pericarditis and how to treat this condition.

Symptoms of acute pericarditis

Inflammation and swelling of the thin, saclike tissue that surrounds the heart (pericardium) is called pericarditis. Stabbing chest discomfort is a common symptom of pericarditis. Chest discomfort results when the inflamed pericardial layers rub together. The pericardium’s function is to keep the heart healthy and free of infection by acting as a barrier and a lubricant.

Multiple signs and symptoms may indicate acute pericarditis. Depending on what’s triggering your pericarditis, you may be more susceptible to some of these symptoms. These are some of the possible symptoms:

  • Chest pain that gets worse when you take a deep breath or lie down and can be relieved by leaning forward
  • Fever
  • Difficulty breathing (dyspnea)
  • Irregular or rapid heart rate (tachycardia)
  • Muscle aches and pains
  • Difficulty swallowing or hiccups (dysphagia)
  • Dry cough
A woman with chest pain, one of the signs and symptoms accompany a diagnosis of acute pericarditis

Constrictive pericarditis can cause swelling in the feet, legs, and ankles, as well as shortness of breath after physical activity. This type of pericarditis is characterized by thickening and/or hardening of the pericardium. In this condition, the heart’s ability to pump blood effectively is impaired because the heart muscle is unable to expand.

If your heart is squeezed, blood will pool in your lungs, belly, and legs, producing swelling and other signs of congestive heart failure. It’s also possible to get an irregular heartbeat.

What causes acute pericarditis?

The pericardium has two layers separated by a thin layer of fluid. This fluid ensures that the interaction between the membranes remains smooth. The two layers will rub against one another if the pericardium is inflamed and swollen.

The underlying cause of pericarditis is often unknown.

Idiopathic pericarditis is the medical term when doctors don’t know what’s causing it. Many occurrences have been attributed to undetectable infections.

There is a wide range of potential causes for acute pericarditis. Some of them are:

  • Infections: These might be anything from a bacterial illness like tuberculosis to a viral infection like HIV. Although fungal and parasitic pericarditis sometimes occurs, it is extremely uncommon.
  • Cancer: Cancer of the pericardium is uncommon, although it does occur. When tumors expand from other parts of the body, they can harm the pericardium and cause pericarditis.
  • Inflammatory or immune illnesses: Lupus, rheumatoid arthritis, and Sjögren’s syndrome are all examples of autoimmune diseases that can lead to pericarditis.
  • Hormonal disorders: Ovarian hyperstimulation syndrome and hypothyroidism (when the thyroid gland does not produce enough hormones) can cause pericarditis.
  • Metabolic or deposition storage diseases: Amyloidosis (protein storage disease) and hemochromatosis (iron deposition disease), for example, can often cause pericarditis.
  • Trauma: The pericardium can become inflamed and irritated as a result of chest trauma — both blunt-impact and penetrating injuries, like knife or gunshot wounds.
  • Circulatory or heart disease: Some examples of this include heart attacks and aortic dissections.
  • Medical causes: Acute pericarditis can occur as a complication of cardiac surgery, radiation therapy for cancer, or certain medications.

Heart failure, chronic renal disease, kidney failure, liver cirrhosis, and other conditions can all contribute to the onset of acute pericarditis.

How is pericarditis diagnosed?

If you have a piercing pain in your chest and shoulders that subsides as you sit up and lean forward, along with chest discomfort when you breathe, these are strong indications that you may have pericarditis rather than a heart attack.

Your doctor will want to know about any recent illnesses you may have had, as well as any heart ailments, surgeries, or other health issues that place you at risk for pericarditis.

Your health care provider will pay attention to your heartbeat. Whenever your inflamed pericardial lining rubs against itself, you’ll hear a rubbing or creaking sound known as the pericardial friction rub.

If you lean forward, hold your breath, and exhale, your doctor will be able to hear your chest sounds better. Crackles in the lungs are an indication of fluid in the pleural space or excess fluid in the pericardium, both of which can be detected by your doctor, depending on the severity of the inflammation.

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Diagnostic tests for acute pericarditis

Pericarditis can be diagnosed in a number of ways. One or more of the following tests may be necessary for you:

  • X-ray of the chest to determine the size of the heart and any fluid in the lungs
  • Acute pericarditis ECG (also known as an EKG) to detect any abnormalities in the heart’s electrical activity. Pericarditis is characterized by abnormal cardiac rhythms in around half of the patients. For some people, nothing ever changes. If so, it might only be for a short time.
  • Echocardiogram (echo) to evaluate cardiac function and detect pericardial effusion (fluid accumulation around the heart). Constrictive pericarditis is diagnosed with an echo because of the clear symptoms of a thicker or rigid pericardium, which limits the heart’s usual movement.
  • Cardiac MRI to detect excess fluid in the pericardium, inflammation or thickening of the pericardium, and heart compression. In order to see your organs more clearly during this particular scan, your doctor will inject you with a contrast substance called gadolinium.
  • CT scan of the chest to detect calcium in the pericardium as well as fluid, inflammation, tumors, and illness in the tissues around the heart. For a more in-depth look at the inflammation, your doctor will use iodine dye in the test. Doctors may recommend this test particularly for those who have symptoms of constrictive pericarditis and suspect they may benefit from surgical intervention.
  • Cardiac catheterization to determine the filling pressures within the heart. Constrictive pericarditis can be diagnosed using this test.
  • Blood tests, including various tests for infectious causes, such as HIV, Epstein-Barr virus, or tuberculosis, as well as an autoimmune workup

How to treat acute pericarditis

Pericarditis treatment varies based on the severity of the condition and its cause. In less severe situations, your doctor may decide to take no action at all, as the condition often resolves itself without any treatment. Medication is typically the initial treatment option when it’s needed.


Options for drug-based therapy include:

  • Over-the-counter NSAIDs: Aspirin and ibuprofen are examples of over-the-counter NSAIDs that can help with a lot of the pain and inflammation that come with pericarditis. Extreme painkillers are available with a doctor’s prescription as a last resort.
  • Colchicine: If the pericarditis causes severe pain or comes back repeatedly, your doctor may recommend colchicine. This medication’s anti-inflammatory properties allow it to shorten the episode and stop it from returning. There are, however, many people who should not take it due to existing conditions. Abdominal discomfort, nausea, and diarrhea are some of the potential negative side effects.
A woman taking pills to treat acute pericarditis
  • Corticosteroids: If previous treatments have failed, your doctor may recommend corticosteroids. Steroid treatment for acute pericarditis increases the risk of a subsequent recurrence. This is why they should be your very last resort. Some of the negative side effects of this treatment are increased perspiration, mood fluctuations, and weight gain.
  • Antiviral or antimicrobial treatments: Infectious pericarditis treatment also requires specific antimicrobial, antiviral, or antifungal treatment, depending on what’s causing it, along with a short course of treatment with NSAIDs, colchicine, and pericardial drainage.

Other procedures

A variety of surgical procedures are available if drugs fail to relieve symptoms.

  • Pericardiocentesis: A tiny tube is placed into the pericardial cavity to remove excess fluid. It’s possible that the tube will stay in for a few days.
  • Pericardiectomy: If the pericardium has become very stiff and is placing additional strain on the heart, the whole sac may be removed surgically in a procedure known as a pericardiectomy. Due to the extremely low survival rate associated with this procedure, it is reserved for extreme cases.

How long does acute pericarditis last?

The severity of pericarditis can range from a non-life-threatening condition to one that requires immediate medical attention. The condition can be made worse by the accumulation of fluid in the pericardium and by cardiac dysfunction.

When pericarditis is diagnosed early, the prognosis is favorable. Most patients feel better in two weeks to three months. On the other hand, pericarditis can recur. In the event that the symptoms or episodes keep coming back, doctors call it chronic.


One of the heart conditions that is most likely to cause discomfort is acute pericarditis. Even while the condition itself is typically not life threatening, it can present symptoms that are very similar to those of a heart attack, which is a condition that requires immediate medical attention.

Acute pericarditis can also lead to complications, such as cardiac tamponade, which is a life-threatening medical emergency.

You shouldn’t wait too long to get these symptoms checked out by a health care expert because of the similarities and connections between them.

Acute pericarditis is normally curable; however, some people may have symptoms of the condition more than once in their lifetime. You should always follow pericarditis treatment guidelines provided by your doctor.

February 20, 2023