Pericarditis is inflammation of the pericardium — the thin, double-layered sac surrounding the heart. It's a common cause of sharp chest pain that's often mistaken for a heart attack, but most cases are benign and resolve with simple treatment.
What Is Pericarditis?
Inflammation of the pericardium, the protective sac around the heart, which normally contains a small amount of lubricating fluid that lets the heart move smoothly as it beats.
What's Happening in Your Heart
Inflammation of the pericardium's two layers causes them to rub against each other with each heartbeat — sometimes creating a distinctive sound (a pericardial friction rub) your doctor can hear with a stethoscope — and can cause sharp, positional chest pain. In some cases, inflammation leads to extra fluid accumulating between the layers (a pericardial effusion), and rarely, enough fluid builds up quickly enough to compress the heart (cardiac tamponade, a medical emergency).
Types & Causes
- Viral or "idiopathic" (no clear cause found) — the most common category by far
- Post-cardiac injury — after a heart attack, heart surgery, or a cardiac procedure (a well-recognized pattern sometimes called Dressler syndrome when it occurs weeks after a heart attack or surgery)
- Autoimmune conditions (like lupus or rheumatoid arthritis)
- Uremic — related to advanced kidney failure
- Bacterial, fungal, or tuberculous infection — less common, but important to consider
- Cancer-related, either from cancer itself or from radiation to the chest
Common Symptoms
Sharp, stabbing chest pain that's often worse lying flat and improves sitting up and leaning forward, sometimes worse with deep breathing or coughing, and sometimes radiating to the shoulder or back. Low-grade fever is common. Symptoms often follow a recent viral illness.
How It's Diagnosed
An ECG (often shows characteristic widespread changes), an echocardiogram (checks for a pericardial effusion and assesses how well the heart is filling), and blood work (inflammatory markers, and troponin to help distinguish from more direct heart muscle involvement). Cardiac MRI adds detail in more complex or recurrent cases. (See Cardiac Testing & Imaging.)
Main Treatment Options
NSAIDs (like high-dose ibuprofen or aspirin) plus colchicine are first-line for most cases and are typically continued for weeks, tapered rather than stopped abruptly, since stopping too early is a common reason for recurrence. Corticosteroids are generally reserved for cases that don't respond to first-line treatment or specific situations, since they're actually associated with a higher recurrence rate when used too early. Treating an identified underlying cause (an infection, autoimmune condition) when relevant. Drainage (pericardiocentesis) is needed if a significant effusion is causing tamponade — a true emergency procedure.
Lifestyle Changes That Help
- Restricting vigorous exercise until symptoms and inflammatory markers have resolved, typically weeks to a few months depending on severity
- Taking the full prescribed course of anti-inflammatory medication and completing the taper rather than stopping once you feel better
- Follow-up with your care team if symptoms recur, since recurrent pericarditis is common enough to have its own specific management approach
Living With It
Most people recover fully within a few weeks with treatment. A meaningful minority — perhaps 15-30% — have at least one recurrence, and a smaller group goes on to have multiple recurrences requiring longer-term management, occasionally including newer medications specifically approved for recurrent pericarditis. Rarely, chronic inflammation leads to a stiff, scarred pericardium (constrictive pericarditis) that can itself cause heart failure symptoms and may eventually need surgical removal of the pericardium.
When to Call Your Doctor vs. Go to the ER
- Mild, stable chest discomfort that matches a pattern you've already had evaluated
- New or severe chest pain, shortness of breath, fainting, or lightheadedness — especially any sign of tamponade like worsening shortness of breath with a fast heart rate and low blood pressure
Common Questions
Is this a heart attack?
No, though the sharp chest pain can feel alarming and needs to be evaluated the same way at first — the underlying mechanism (inflammation of the sac around the heart vs. a blocked artery) and treatment are completely different.
Why does leaning forward help?
Leaning forward shifts the heart slightly away from the inflamed pericardial surfaces, which is why it's a classic, genuinely useful sign your doctor asks about.
Can this come back?
Yes, in a meaningful minority of people — completing your full course of medication (including the taper) as prescribed is one of the best ways to reduce that risk.
What is cardiac tamponade?
A dangerous buildup of fluid around the heart that compresses it and prevents it from filling properly — a true emergency requiring urgent drainage, though it's an uncommon complication of pericarditis overall.