Pericarditis is the inflammation of the pericardium, a thin two-layered sac that surrounds the heart, protects it and keeps it in place.

A small amount of fluid between the two layers of tissue keeps the layers separate so there’s no friction between them. When the two layers become inflamed, it can cause chest pain.

The cause of pericarditis is unknown, although viral infections are believed to be a common cause. Often, pericarditis occurs after a respiratory infection.

Other causes of pericarditis include:

• Heart attack or heart surgery
• Medical conditions such as kidney failure, cancer, HIV/AIDs or tuberculosis
• Medications such as blood thinners or those used to treat irregular heartbeats

Most cases of pericarditis are mild and can clear up with rest or simple treatment. In many instances, pericarditis can come on suddenly, but goes away within a short time. One of the most common signs of pericarditis is a sharp, stabbing pain in the middle or left side of the chest. You may also feel pain in the shoulders.

Some symptoms of pericarditis include:

• A sharp, stabbing pain in the middle or left side of the chest. Sitting up or leaning forward may ease the pain but the pain worsens when laying down or taking a deep breath.
• Pain in one or both shoulders
• Fever
• Weakness
• Difficulty breathing
• Coughing
• Heart palpitations or flutter

For some people, pericarditis can develop into a chronic or recurring condition caused by autoimmune disorders such as lupus, rheumatoid arthritis or scleroderma.

With chronic cases of pericarditis, chest pain is usually not one of the symptoms. In these types of cases, tiredness, shortness of breath and coughing are common symptoms. In more severe cases, symptoms may also include low blood pressure and swelling in the stomach or legs.

Pericarditis can sometimes lead to cardiac tamponade or chronic constrictive pericarditis, both serious complications.

• Cardiac tamponade occurs when too much fluid is in the sac. This puts pressure on the heart and prevents it from properly filling with blood, resulting in a drop in blood pressure. If untreated, cardiac tamponade can be fatal.
• While rare, chronic constrictive pericarditis is a disease that can cause scar-like tissue in the sac around the heart. The sac can become stiff and constrict the heart, preventing it from properly functioning.

Often your doctor can diagnose pericarditis by listening to your chest with a stethoscope. A common sign of pericarditis is the pericardial rub, or the sound of the pericardium rubbing against the outer layer of the heart. Your doctor may also hear other signs of fluid in the pericardium or in your lungs.

In some cases, additional tests may be needed to determine the severity of the pericarditis. Some of those tests may include blood work, echocardiogram, electrocardiogram, chest X-rays, CT scan or MRI scan.

Treatment of pericarditis may vary based on your condition. Goals of treatment often include reducing the pain and inflammation around the heart, treating the underlying cause of pericarditis (such as a viral infection) and checking for any complications.

In addition to rest, your doctor may prescribe an over-the-counter anti-inflammatory or other medications, such as prednisone, to alleviate the pericarditis. In more serious cases, a hospital stay or surgical procedure may be needed. Recovery can take weeks or months, depending on the severity of the case.

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