Pericarditis

Pericarditis is inflammation of the pericardium — the thin sac that surrounds the heart. It often causes sharp chest pain. Most cases are mild and get better in a few weeks, but some are serious and need hospital care.

Symptoms

• Sharp or stabbing chest pain, often behind the breastbone — typically worse when lying flat, breathing in, or coughing; better when sitting up and leaning forward
• Pain may spread to the left shoulder or neck
• Fever
• Tiredness, weakness
• Shortness of breath (especially lying down)
• Dry cough
• Palpitations

Pericarditis pain can be hard to tell apart from other causes of chest pain — including heart attack — so any new chest pain deserves medical evaluation. Dial 112 for severe, sudden, or crushing chest pain, or chest pain with breathlessness, sweating, or arm/jaw pain.

Causes

• Viral infections — most common cause
• Bacterial infections, including tuberculosis (an important cause in India)
• After a heart attack or heart surgery
• Autoimmune conditions — lupus, rheumatoid arthritis
• Kidney failure
• Cancer, radiation
• Some medicines
• Often, no specific cause is identified (idiopathic)

Complications

• Pericardial effusion — fluid build-up around the heart. Large effusions can compress the heart (cardiac tamponade) — an emergency.
• Constrictive pericarditis — long-term scarring that stops the heart from filling properly. TB pericarditis is a particularly important cause in India.

Diagnosis and treatment

• ECG, echocardiogram, blood tests, chest X-ray; sometimes CT or MRI
• Tests for underlying causes — TB testing, autoimmune markers, kidney function
• Treatment — anti-inflammatory medicines for pain and inflammation; sometimes colchicine; treating the specific underlying cause (antibiotics for bacterial, anti-TB medicines for TB, and so on)
• Drainage of large effusions; rarely, surgery for constrictive pericarditis

Most acute pericarditis settles fully. Recurrence is possible — regular follow-up helps prevent long-term complications.