Mark, a healthy young man in his late 30s, felt a sharp, stabbing pain in his chest that came on out of the blue. He tried to ignore it and lay down to wait it out, but that made the pain worse. Thinking he was having a heart attack, he rushed to the emergency room, but after extensive testing, it turned out it wasn’t a heart attack. It was pericarditis.
In all likelihood, you’ve never even heard of pericarditis—most people haven’t. But this little-known condition is a relatively common cause of chest pain, especially in men ages 20 to 50.
Signs & Symptoms of Pericarditis
What is pericarditis? It’s inflammation of the pericardium—a tough, double-layered, fibrous sac that surrounds the heart, anchors it in place, keeps it lubricated, and protects against infection.
When the pericardium is inflamed and swollen, the two layers may rub up against each other, causing sharp chest pain. The pain usually comes on suddenly and, as Mark experienced, may feel like a heart attack. In fact, pericarditis is diagnosed in around 5% of people who go to the ER for chest pain.
The pain tends to worsen when lying down, coughing, or taking deep breaths and ease up when leaning forward. I’ve had patients who were afraid to breathe because it was so uncomfortable.
Depending on the underlying cause, other symptoms may include fever, fatigue, or palpitations.
How Is it Diagnosed?
A diagnosis of pericarditis can often be made bedside right in the emergency room, with a physician listening to your heart for the telltale friction rub (scratching sound) that’s caused by the rubbing of the layers of the pericardial sac. As a physician, once you have heard it the first time, you will never forget it.
If pericarditis is suspected, your doctor will usually order an echocardiogram to see if you have pericardial effusion, which is excess fluid around the heart. An EKG, chest X-ray, and other tests may also be performed.
How Do You Get Pericarditis?
Although pericarditis is often “idiopathic” (of an unknown cause), common culprits include:
- Infections: Most cases of pericarditis are viral. It’s the leading cause in the US and is presumed to be responsible for many cases of idiopathic pericarditis. In developing countries, bacterial infection, especially tuberculosis, is a primary cause.
- Tumors: Tumors adjacent to the pericardium can also cause inflammation of the pericardial sac. I remember treating a woman in her mid-30’s who had breast cancer that spread to the pericardium and she was very uncomfortable with it. The thoracic surgeon had to put a tube to drain the fluid from the pericardial sac.
- Heart attack: Sometimes pericarditis can develop after a heart attack if heart damage extends into the pericardium and elicits an inflammatory response. In fact, sometimes a heart attack may be overlooked by a patient—yet diagnosed when pericarditis develops a few days later. Plus, a delayed form, called Dressler’s syndrome, may come on weeks later.
- Coexisting conditions: Other potential causes of pericarditis include autoimmune diseases such as rheumatoid arthritis and lupus, trauma or radiation to the chest, and serious diseases like kidney failure.
How to Treat Pericarditis
As alarming as chest pain can be, pericarditis is usually mild and may even clear up on its own. Although there are no pericarditis medications, per se, these treatments are usually effective when prescribed by your doctor:
- NSAIDs: Aspirin, Advil, Motrin, and other over-the-counter NSAIDs are the treatment of choice for viral and idiopathic pericarditis.
- Colchicine: This anti-inflammatory, best known for treating and preventing gout, is often given in conjunction with NSAIDs. In addition to relieving pain and inflammation, it may help prevent recurrences.
- Corticosteroids (prednisone): If symptoms persist or recur, these potent anti-inflammatories may be prescribed.
- Antibiotics: Bacterial pericarditis requires antibiotics.
How long pericarditis lasts depends on the cause. Most episodes respond well to these treatments—plus a little R&R—and last a few weeks at most.
Unfortunately, 15–30% of patients have a repeat episode, and some people develop chronic or recurrent pericarditis. Seeking prompt treatment, working with your doctor, and resting up during recovery can reduce this risk. However, in rare cases, serious complications can occur:
- Constrictive pericarditis: Chronic inflammation may damage the pericardium, causing it to become inelastic and stiff. This restricts the heart’s ability to fill with blood and can lead to symptoms similar to diastolic dysfunction and heart failure, such as shortness of breath, fatigue, and swelling in the legs.
- Cardiac tamponade: This potentially fatal condition is caused by the accumulation of excessive fluid in the pericardium. The resulting pressure on the heart compromises function and requires emergency treatment. Drainage of the pericardial sac reduces pressure, but additional pericarditis surgery may also be necessary.
The good news is that these complications are rare. Most people will recover within a few weeks.
Pericarditis Risk Factors & Prevention
The American Heart Association says there’s nothing you can do to prevent pericarditis. But what I’ve found is that there’s a lot you can do to keep it at bay.
As noted above, infections, heart attacks, and a number of coexisting medical conditions are the most common underlying causes—and in my practice, I found that you can most certainly take steps to minimize these risks.
- Boost your immune system: Rejuvenating sleep, a good diet and exercise program, weight and stress management, and a daily multivitamin plus extra vitamin D have been shown to enhance immune function.
- Get a handle on chronic conditions: A healthy lifestyle is also the first step to taming autoimmune diseases and other disorders associated with pericarditis. Work with your doctor, but also check out integrative therapies, which are safer and often equally effective.
- Focus on heart health: Preventing heart attacks—a leading cause of heart damage and pericarditis—with lifestyle changes, weight loss, and a comprehensive supplement program that includes coenzymeQ10, omega-3s, magnesium, and L-carnitine should be a priority for everyone.