Pericarditis: Symptoms, Causes, Treatments
It's an inflammation of the thin sac that surrounds your heart, and lets it move easily as it beats. When this two-layered lining gets inflamed, the layers can rub together. That can cause sharp chest pain or other symptoms.
Most pericarditis cases are mild, and serious complications are rare. Pericarditis usually doesn't affect how long you live or cause lasting damage to your heart. Even if it comes back, there are good ways to manage it.
"We can control recurrent pericarditis very effectively with safe drugs, and there's a lot of research and momentum to make the treatment even better," says Luigi Adamo, MD, PhD, director of cardiac immunology at Johns Hopkins University.
Still, chest pain should always be checked out. See your doctor right away to make sure it's not something more serious.
Pericarditis vs. myocarditis
Pericarditis affects the lining around your heart. Myocarditis is inflammation of the heart muscle (called the myocardium).
They can feel similar. Both can cause chest pain, shortness of breath, or changes in your heartbeat. They can also happen after an infection or with conditions that cause inflammation in your body.
The key difference is where the problem is. Pericarditis involves the outer lining. Myocarditis affects the heart muscle, which pumps blood. Because of that, myocarditis is usually more serious and more likely to lead to complications.
Pericarditis can feel a little different for everyone. But most people notice chest pain first. It usually starts in the center or left side of your chest, near your breastbone, and may change with movement or breathing.
"Like you take a deep breath, and your chest pain gets worse," says Attila Feher, MD, PhD, an assistant professor at Yale University School of Medicine who specializes in cardiovascular imaging and cardio-rheumatology.
The pain can also:
Get worse when you cough or lie down
Feel better when you sit up or lean forward
Spread to your left shoulder or upper back
Feel sharp, or sometimes dull and achy
Depending on the cause, you might also have:
A dry cough
Tiredness or low energy
A general "sick" feeling
A low fever
Anxiety, especially if the symptoms feel sudden or intense
How long do pericarditis symptoms last?
Most people start to feel better in a few weeks.
But symptoms can last longer or come back, especially if the inflammation isn't fully controlled. In some cases, pericarditis can return weeks or even months later.
Doctors group pericarditis in two main ways: by how long it lasts and how it shows up.
Types based on how long it lasts:
Acute (short-term) pericarditis. This is the most common type. Symptoms come on suddenly and often get better within a few weeks with treatment. The chest pain can feel like a heart attack, so many people go to the emergency room.
Recurrent pericarditis. This means symptoms come back after you've felt better for a while, usually at least four to six weeks. It can happen in around 1 in 3 people who get pericarditis.
Incessant pericarditis. Symptoms don't fully go away. They last more than four to six weeks but less than three months, even with treatment.
Chronic pericarditis. Symptoms last longer than three months. They may be less sharp and more subtle, like fatigue, coughing, or shortness of breath.
Constrictive pericarditis. This is a rare but more serious form. The lining of your heart becomes thick and stiff, which makes it harder for your heart to fill and pump blood. You may get swelling in your legs or belly or feel out of breath (especially with activity).
Types based on cause:
Infectious pericarditis. Caused by an infection. Viruses are the most common trigger, but other germs can also be involved.
Idiopathic pericarditis. "Idiopathic" is a term used to describe any disease that doesn't have a clear cause. But many idiopathic pericarditis cases are likely triggered by a virus or an immune response, even if doctors can't pinpoint the exact reason.
Autoimmune-related pericarditis. This is linked to conditions where your immune system attacks your own body, like lupus or rheumatoid arthritis.
Uremic pericarditis. It can happen with advanced kidney disease, when waste builds up in your blood (uremia).
Posttraumatic pericarditis. You may get pericarditis if you take a big hit to the chest, such as in a car crash. Symptoms may show up days or weeks after your injury.
Cancer-related (malignant) pericarditis. People with cancer sometimes get pericarditis. This can happen if you have a tumor directly on your heart or when cancer cells spread from other parts of your body.
In many cases, especially early on, doctors focus less on finding the exact cause and more on treating the inflammation and preventing it from coming back.
For a long time, doctors didn't fully understand why pericarditis happens. They still can't predict who'll get it. But we now know a key part of the process involves the immune system.
A protein called interleukin-1 can drive inflammation. When it's overactive, it can trigger and keep the irritation around your heart going.
In many cases, pericarditis starts after your body fights off an illness or reacts to another health problem. Sometimes, it's the infection itself. Other times, it's your immune response.
Common triggers include:
Infection. Viruses are the most common cause. These include:
Cold or flu viruses
COVID-19
Coxsackievirus
Respiratory syncytial virus (RSV)
Less often, pericarditis can be caused by:
Bacteria
Fungi
Parasites
Autoimmune conditions. These happen when your immune system attacks your own body, including the lining around your heart.
Examples include:
Sjogren's syndrome
Scleroderma
Rarely, inflammatory bowel diseases like Crohn's disease or
can also play a role.
Other health conditions. Some medical issues can make pericarditis more likely, including:
A recent heart attack
Kidney failure (uremia)
HIV or AIDS
Tuberculosis
Cancer
Radiation therapy to the chest (such as for breast or lung cancer) can also irritate the heart lining.
Medication. In rare cases, certain drugs can trigger pericarditis.
These include some:
Antibiotics
Antidepressants
Anti-anxiety drugs (benzodiazepines)
Water pills (diuretics)
Heart medications
Seizure medications
Surgery or trauma. Pericarditis can happen after heart surgery or a chest injury, like a car crash or sports accident. Symptoms may show up days or even weeks later.
After vaccination. Rarely, pericarditis can happen after certain vaccines, including those for COVID-19. When this happens, it's likely related to the immune response, not the vaccine itself.
Can stress cause pericarditis?
Stress by itself isn't a direct cause.
But intense emotional stress can sometimes weaken your heart muscle (called broken heart syndrome). Ongoing stress can also raise your odds of having things like high blood pressure, which can affect your overall heart health.
For pericarditis, the main driver is inflammation, not stress.
Pericarditis can happen to anyone, but certain things raise your odds of getting it. They include infections, a prior heart attack, or chest trauma.
Your pericarditis risk may also be impacted by:
Age and sex. Pericarditis happens most often in young and middle-aged adults. This commonly includes males ages 16-65.
Genetics. Your genes give your body instructions for responding to inflammation. This may be why certain people are more likely to get unexplained pericarditis than others.
Inherited health conditions. You're more likely to get pericarditis if you're born with certain conditions that affect how your body makes inflammation, including rare conditions such as:
Familial Mediterranean fever
Tumor necrosis factor receptor-associated periodic syndrome (TRAPS)
Lifestyle choices. Your heart and immune system may not work as well if you drink too much alcohol or use stimulants such as cocaine, amphetamines, or drugs you put in your body through a vein in your arm.
How common is pericarditis?
Around 28 people out of 100,000 get pericarditis every year. But if you have one episode, you're more likely to get this kind of inflammation again.
To figure out if you have pericarditis, your doctor will start with your symptoms and health history. Be as specific as you can. Chest pain can have many causes, and pericarditis is just one of them.
"Pericarditis can be a challenge to diagnose. Because if you're not thinking about it as a cause, you could totally miss it," Feher says.
It helps to tell your doctor if you've:
Been sick recently
Had a recent injury or surgery
Been diagnosed with an autoimmune disease
Had pericarditis before
Your doctor will also do a physical exam and listen to your heart. In some cases, they may hear a "pericardial rub." This is a scratchy sound caused by the inflamed layers rubbing together.
What tests are used to diagnose pericarditis?
There's no single test that confirms pericarditis. Doctors usually put together a few clues from your symptoms, exam findings, and test results.
You may get:
Blood tests. Check for signs of a heart attack, inflammation, or autoimmune diseases
Echocardiography (echo). Uses sounds waves to check heart function and check for fluid buildup
Cardiac magnetic resonance imaging (cardiac
). Gives detailed images that can show inflammation around the heart
Electrocardiogram (EKG or ECG). Checks your heart's electrical activity
Chest X-ray. Looks for an enlarged heart or extra fluid around it
Cardiac computed tomography (cardiac CT). Takes detailed pictures to look for problems around your heart
Cardiac catheterization:Measures the pressure in your heart
Treatment depends on the cause and how serious your symptoms are. The goals are to ease pain, reduce inflammation, and prevent complications. Most people improve with medication and rest. Surgery is only needed in certain cases.
Medications for acute or persistent pericarditis
Nonsteroidal anti-inflammatory drugs (NSAIDs). These are usually the first step. Drugs such as
or
can reduce pain and inflammation for many people.
. This is often added early. It helps calm inflammation and lowers the risk that pericarditis will come back. Many people stay on it for a few months. Your doctor will decide if it's safe for you, especially if you have liver or kidney disease or take certain medications.
Corticosteroids. Steroids such as
may be used if other treatments don't work or aren't safe for you. But doctors use them carefully. They can raise the risk that symptoms come back, especially if used too early or stopped too fast.
Interleukin-1 (IL-1) blockers. Newer targeted treatments work well for recurrent or hard-to-treat inflammatory cases with persistent symptoms. These include interleukin receptor-1 antagonists, such as:
(
)
Canakinumab (
)
Rilonacept (
)
These drugs target a key part of the immune system that drives inflammation. Blocking IL-1 can help control symptoms and prevent repeat flares in most people. If you have recurrent pericarditis, your doctor may suggest you take them for up to two years.
Other medications. Depending on the cause of your symptoms, you may need:
Prescription painkillers (if over-the-counter drugs aren't enough)
Antibiotics (for bacterial infections)
Diuretics (if fluid buildup affects heart function)
Procedures for pericarditis
Your doctor may need to take extra steps to get rid of fluid or tissue. This buildup can put pressure on your heart and affect how well it works.
Surgeries or procedures for pericarditis include:
Pericardiocentesis (thin needle and tube are used to drain fluid)
Pericardiectomy (surgery to remove part or all of the pericardium)
In most cases, medication works well. The key is controlling inflammation early and staying on the plan long enough to prevent it from coming back. You usually only need surgery in serious or long-term cases, like constrictive pericarditis.
You may not have any serious or long-lasting problems, especially if you get treatment early on. But some complications of pericarditis might include:
Constrictive pericarditis
Over time, too much inflammation can thicken your pericardium. If the sac around your heart gets too stiff, your heart may not be able to fill and pump blood to the rest of your body. This isn't a common complication of pericarditis, but you should tell your doctor if you think you have it.
Signs and symptoms of constrictive pericarditis may include:
Swelling in your legs and belly
Shortness of breath
Tiredness
Chest pain
Dizziness
Feeling full fast
Loss of appetite
Your doctor will ask you some questions and run some tests to find out if you have constrictive pericarditis and to go over the next steps of your treatment, which may include surgery.
Pericardial effusion
Fluid may build up around your heart when your pericardium is inflamed. This can put pressure on your heart so it can't fill with blood and pump it back out.
Cardiac tamponade
Pericardial effusion can put so much pressure on your heart that it can't fill and empty properly. If this happens quickly, you may not get enough oxygen to the rest of your organs. This is life-threatening and requires medical treatment right away.
Pericarditis and COVID
Like other infections, the virus that causes COVID-19 may trigger an overreaction from your immune system that results in too much inflammation around your heart. While the chances this'll happen are low, people who get COVID are about 35 times more likely to have myocarditis or pericarditis than those who don't get an infection.
Your odds of pericarditis also go up if you get long COVID – when you have lingering symptoms of the illness even though you've cleared the virus from your body. This risk seems to be higher in people who already have an autoimmune disease or allergies.
Less often, the COVID mRNA vaccine may lead to pericarditis (or myocarditis). The odds of this happening are far lower from the vaccine than if you get the infection. Talk to your doctor to see what vaccines are right for you.
If you (or your child) has pericarditis, it helps to know what's going on and what comes next. This condition can feel unpredictable, especially if symptoms come back. Clear answers can help you feel more in control.
Here are some key questions to ask:
Did something specific cause this?
How do you know this is pericarditis and not something else?
What treatment do I need, and for how long?
Are there activities I should avoid right now?
When can I return to my exercise routines?
What symptoms should I watch for?
What are the chances it will come back?
When should I come back or get follow-up testing?
Could this lead to complications?
What should I do if my symptoms return?
How can I take care of myself while I recover?
Is it normal to feel anxious about this, and what can help?
When should I call or go to the emergency room?
Are new treatments, like IL-1 blockers, something I might need?
The best way to manage pericarditis is to control inflammation early and stay consistent with your treatment. So it's especially important to ask about your plan, how long to follow it, and what to do if symptoms return.
Most people start with a primary care doctor or, for kids, a pediatrician. They can check for other causes of chest pain and refer you to a cardiologist. These are heart specialists. They often guide diagnosis and treatment, especially if your symptoms keep coming back or they're persistent despite treatments.
In some cases, you may need a team approach.
For example, if your pericarditis is linked to an autoimmune disease (like lupus or rheumatoid arthritis), a rheumatologist will often be part of your care team. An infectious disease specialist may weigh in if there's concern about a bacterial or unusual infection.
If symptoms return or don't respond to standard treatment, it helps to see a cardiologist with experience in recurrent pericarditis. This condition is driven by inflammation, and getting the treatment plan right early on can lessen repeat flares and long-term problems.
You don't always need a long-term specialist. You can usually go back to seeing your regular doctor once you get better. But if your case is hard to treat, your symptoms persist despite treatments, or your symptoms keep coming back, ongoing follow-up with a cardiologist is a good idea.
You can ask your doctor or cardiologist for a referral to a pericarditis specialist. You can also use the American Heart Association's
Addressing Recurrent Pericarditis
page to find experienced care teams.
After a pericarditis diagnosis, your care will focus on calming inflammation and keeping a close eye on your symptoms.
You'll likely start medication right away. Even if you feel better in a few days, you'll need to keep taking it for several weeks or longer to fully control the inflammation and lower the odds that it will come back.
Long-term follow-up is usually based on how you feel. Your doctor may check in to see if your pain is improving and whether symptoms are returning, rather than repeating lots of tests, unless something changes.
You'll also need to take it easy for the first month or so. Many doctors suggest avoiding sustained physical activity that boosts your heart rate above 100 beats per minute. Once your doctor clears you, you can ease back into your usual exercise routine.
The chances you'll have pericarditis complications depend on why you got inflammation in the first place. Your doctor may watch you more closely if you've had a serious infection, cancer, or other health conditions.
Pericarditis often starts suddenly, but it doesn't always last. For many people, especially when it's caused by a virus, symptoms get better within two to six weeks with the right treatment.
Early on, you may have sharp chest pain, fatigue, or pain that gets worse with deep breaths or certain positions. As the inflammation settles down, those symptoms usually go away.
In some cases, symptoms come back after you start to feel better. This is called recurrent pericarditis. It can happen weeks, months, or even longer after your first episode. Your doctor may change your treatment or extend it to lower the chances of this happening.
Over time, most people do well. Serious problems aren't common.
Your doctor may watch for things like fluid buildup around the heart or ongoing inflammation. That helps lessen the chances the condition becomes recurrent or harder to treat over time.
Recovery is about giving your body time to heal while keeping inflammation under control
Here are some tips to help you recover:
Take your medications exactly as prescribed.
Rest and avoid intense activity until your doctor clears you.
Ease back into exercise slowly.
Watch for symptoms like chest pain, shortness of breath, or feeling faint.
Get enough sleep and stay hydrated.
If your symptoms don't improve, or they return, check back with your doctor. You may need a change in treatment.
Can you prevent pericarditis?
There's no sure way to prevent pericarditis, especially the first time. But you can lower your risk by protecting your heart and avoiding getting sick from germs like viruses.
To reduce your risk of infection, you can:
Avoid close contact with people who are sick.
Wash your hands often.
Stay up to date on recommended vaccines.
To protect your heart:
Don't smoke.
Eat a heart-healthy diet low in salt, saturated fat, and added sugars.
Stay active. (Ask your doctor what's safe.)
Manage conditions like high
and high blood pressure.
If you've had pericarditis before:
Treat infections early
Avoid chest injuries. (Wear a seatbelt, and use protective gear if needed.)
Stay on your treatment plan as directed.
Follow up with your doctor if symptoms return.
Pericarditis can feel isolating, especially if it comes back. Support from others and clear, trusted information can help you manage day to day and feel more in control. There are a couple of groups that'll tell you more about life with pericarditis.
These groups offer education, resources, and support:
You can learn more about how to manage pericarditis through:
National Organization for Rare Disorders
Addressing Recurrent Pericarditis
(American Heart Association)
If you're looking for day-to-day support, you might also ask your doctor about local or virtual support groups or professional mental health support.
It's common to feel shaken after a heart-related diagnosis. Even after your body heals, your mind may stay on high alert.
Many people, especially teens and young adults, start to notice every sensation in their chest. "They're scared it's going to happen again," says Erin Faherty, MD, a Yale Medicine cardiologist who treats young people at the Yale New Haven Children's Hospital.
That reaction makes sense, she says. When something affects your heart, your brain tries to protect you by staying watchful. But over time, that constant focus can add stress or anxiety.
If worry about your symptoms starts to build, a few steps can help:
Ask your doctor which symptoms need fast care and which are less concerning.
Ease back into activity at a pace that feels safe.
Try not to check or scan your body too often.
Talk to someone you trust if anxiety starts to affect your daily life.
Once you've healed, try not to avoid activity altogether. Being inactive for too long can take a toll on your heart and overall well-being.
It can also help to have a clear plan. You may feel less afraid if you know what to expect and what to do if symptoms come back.
You don't have to manage this alone. Your care team can help you take care of both your physical and emotional health.
If your child or loved one has pericarditis, you may feel unsure about what to watch for or how much to worry. The good news is that most cases get better with time and treatment.
Symptoms don't always look the same in everyone. Chest pain is the most common sign, but some people, especially younger kids, may just seem tired, complain of stomach pain, or not act like themselves. If something feels off, trust your gut and check in with a doctor.
You can also:
Help them follow the treatment plan.
Support rest, then a gradual return to activity.
Watch for chest pain, trouble breathing, or lightheadedness.
Make sure your loved one knows to tell you how they feel.
Caring for someone with a heart-related condition can feel stressful. But your care team can help you understand how to support your loved one's recovery.
People of all races and ethnicities can get pericarditis, and the symptoms usually look the same in everyone. But compared to some other groups, Black people are more likely to have pericarditis due to kidney failure or other heart problems.
There are few studies on the differences in pericarditis diagnosis and treatment among racial or ethnic groups.
But researchers have found disparities among other heart conditions, such as:
Black and Hispanic people are less likely to have access to health care or to get good treatment for heart disease, compared to White people.
Black people are less likely to get cardiac catheterization for chest pain.
Black men and women are more likely to die of heart failure and at a younger age, compared to people of other races and ethnicities.
Black men are the least likely group to get care for heart failure from a heart specialist (cardiologist).
Black people are also more likely than people in other racial and ethnic groups to have risk factors for pericarditis, including high blood pressure, diabetes, kidney disease, and heart disease.
Autoimmune conditions such as lupus are also more common among Black women than in some other racial groups.
Pericarditis is inflammation of the sac that surrounds your heart. This swelling usually goes away without causing serious problems. You may only need rest and over-the-counter medication to get better.
Rarely, untreated pericarditis can cause serious complications.
You may not be able to tell the difference between pericarditis and a heart attack. Call 911 or go to the hospital if you have serious chest pain.
Is pericarditis serious? Can it kill you?
It can cause serious issues, but most cases are mild. Excess fluid buildup caused by a pericardial effusion may stop your heart from working the right way. This can be deadly if you don't get treatment right away. Most people recover in a few weeks without any long-lasting problems.
It's possible to die from untreated pericarditis if the inflammation puts pressure on your heart, or causes other problems that stop your heart from pumping blood and oxygen to the rest of your body.
What should I avoid if I have pericarditis?
Your doctor will let you know what's safe, but you'll probably want to skip contact sports or strenuous physical activity until you're fully recovered.
How long do pericarditis flare-ups last?
With rest or medical treatment, a mild episode may start to improve within a few days. Your inflammation may go away completely within four to six weeks if you have acute pericarditis. A full recovery may take a few months or longer if you have chronic pericarditis or need treatment with surgery or another procedure.
Is pericarditis an emergency?
Not usually. But you should call 911 or get medical help right away if you have symptoms such as chest pain, trouble breathing, or swelling in your belly and lower body. You may not be able to tell the difference between pericarditis and something serious.
Can pericarditis be cured?
Most people get completely better, especially with the right treatment. But in some cases, it can come back after you start to feel better. About 1 in 3 people have a recurrence. The odds are higher if inflammation isn't fully controlled or if you stop treatment too soon.
What makes pericarditis worse?
Certain things can make symptoms feel more intense, such as deep breaths or lying flat. Exercise is a little different. Activity that raises your heart rate (often above 100 beats per minute) can actually slow healing. That's why doctors want you to rest early, followed by a gradual return to activity once inflammation is under control.