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Signs and symptoms of pericarditis

A common symptom of acute pericarditis is a sharp, stabbing chest pain, usually coming on quickly. It's often in the middle or left side of the chest, and there may be pain in one or both shoulders.

Sitting up and leaning forward tends to ease the pain, while lying down and breathing deep worsens it. Some people describe the pain as a dull ache or pressure in their chest.

The chest pain may feel like a heart attack. If you experience chest pain, call 911 right away because you may be having a heart attack.

Fever is another common symptom of acute pericarditis. Other symptoms are weakness, trouble breathing and coughing. Palpitations, which are feelings that your heart is skipping a beat, fluttering or beating too hard or too fast, may occur. This can be a sign of deeper heart tissue involvement.

Chronic pericarditis often causes tiredness, coughing and shortness of breath. Chest pain is sometimes absent with this type of pericarditis. Severe cases of chronic pericarditis can lead to swelling in the stomach, feet, ankles and legs and hypotension (low blood pressure).

Complications of pericarditis

Two serious complications of pericarditis are cardiac tamponade and chronic constrictive pericarditis.

• Cardiac tamponade happens if too much fluid collects in the sac, putting pressure on the heart. This prevents the heart from properly filling with blood, so less blood leaves the heart, causing a sharp drop in blood pressure. Untreated cardiac tamponade can be fatal.
• Chronic constrictive pericarditis is a rare disease that takes time to develop. It leads to scar-like tissue forming throughout the sac around the heart. As the sac becomes stiff and unable to move properly, the scarred tissue starts to compress the heart and prevent it from functioning well.

Diagnosing pericarditis

A health care professional diagnoses pericarditis based on your medical history, a physical exam and test results.

Specialists involved

Primary care doctors, such as a family doctor, internist or pediatrician, often diagnose and treat pericarditis. A cardiologist, pediatric cardiologist or infectious disease specialist may be involved, depending on the patient’s age and medical conditions.

Medical history

Your health care professional may ask whether you have had:

• A recent respiratory infection or flu-like illness
• A recent heart attack or injury to your chest
• Other medical conditions

If you have chest pain (angina), you will also be asked to describe how it feels, where it's located and whether it's worse when you lie down, breathe or cough.

Physical exam

When the pericardium is inflamed, the fluid between the sac's two layers of tissue increases. So, your health care professional will look for signs of excess fluid in your chest. A common sign is the pericardial rub. This is detected more often in patients with acute pericarditis than in those with chronic pericarditis. It’s thought that the rub might be the result of inflammation. Your health care professional will listen for this using a stethoscope.

Your health care professional may hear other chest sounds that are signs of fluid in the pericardium (pericardial effusion) or the lungs (pleural effusion). Both are more severe problems related to pericarditis.

Diagnostic tests

The most common tests used to diagnose pericarditis and its severity are:

• Blood tests: May be recommended to find out if you've had a heart attack, the cause of your pericarditis and the amount of inflammation in your pericardium.
• EKG (electrocardiogram): Measures your heart's electrical activity and certain results may suggest pericarditis.
• Chest X-ray: Takes pictures of the inside of the chest, including your heart, lungs and blood vessels. An X-ray can show whether your heart is enlarged due to excess fluid in your pericardium. It may also reveal signs of infection, sarcoidosis or malignancies that may cause pericarditis.
• Echocardiography (Echo): This test uses sound waves to create pictures of your heart, showing its size, shape and how well it's working. It can show fluid build-up in the pericardium.
• Cardiac CT (computed tomography): This type of X-ray takes a clear, detailed picture of your heart and pericardium. It helps rule out other causes of chest pain.
• Cardiac MRI (magnetic resonance imaging): Also called CMR, this test uses magnets and radio waves to form detailed pictures of your organs and tissues. It can show changes in the pericardium.

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