Within the chest cavity, the heart is protected and held in place by a membranous sac called the pericardium. Various issues, including infections, heart attacks, trauma, and autoimmune disorders, can cause the pericardium to become inflamed and swollen — a condition called pericarditis. Depending on the cause, pericarditis can either be acute (short-term) or chronic (long-term). The acute and chronic forms of pericarditis have different symptoms.
Acute Pericarditis Symptoms
Chest pain is the most common symptom of acute pericarditis. This pain is typically described as sharp and stabbing, likely a result of the heart rubbing against the inflamed pericardium (this symptom is sometimes called pericardial rub). Additionally, the chest pain from pericarditis may:
Come on quicklyPrimarily be felt in the middle or left side of the chest, but may also affect the neck, shoulders, back, or abdomenWorsen while lying down and breathing deep, and ease up when sitting up and leaning forwardResemble chest pain from a heart attack
Aside from chest pain, other symptoms of acute pericarditis include fever, weakness, trouble breathing, coughing, and heart palpitations, or a noticeably irregular heartbeat.
Chronic Pericarditis Symptoms
One type of chronic pericarditis is called chronic effusive pericarditis, which develops when excess fluid gathers in the space between the heart and pericardium. Like acute pericarditis, the most common symptom of chronic effusive pericarditis is chest pain. Other common symptoms include tiredness, coughing, and shortness of breath. Severe cases of chronic effusive pericarditis may cause hypotension, or low blood pressure, and swelling in the stomach (ascites) and extremities (edema). A type of chronic pericarditis called chronic constrictive pericarditis may develop as a complication of acute pericarditis. A rare disease, chronic constrictive pericarditis is marked by stiff, scar-like pericardium tissue that restricts the movement of the heart. It can be life threatening, causing the following symptoms:
Difficulty breathingWeakness and fatigueAscites and edemaAbdominal pain, nausea, and vomiting
Pericarditis Diagnosis
Diagnosis of pericarditis begins with your doctor getting your medical history. You’ll be asked about your symptoms, as well as any recent respiratory infections, heart attacks, injuries, and other medical conditions you may have had. The next diagnostic step is a physical exam, during which your doctor will look for signs of excess fluid in your chest and pericardial rubbing — this is typically done with a stethoscope while you are leaning forward and breathing in and out. In severe cases, your doctor may also hear crackles in your lungs, pericardial effusion (fluid between your pericardium and heart), and signs of fluid in the space around your lungs. Your doctor may then order one or more imaging and diagnostic tests, including:
Electrocardiogram, or EKG, which analyses your heart’s electrical activityChest X-rays, which can show if you have an enlarged heart or excess pericardial fluidCardiac computer tomography (CT) scans, which provide more information than chest X-rays and can help rule out other causes of your symptomsCardiac magnetic resonance imaging (MRI), which can show changes in the pericardiumEchocardiography, which uses sound waves to image the heart, examine how well its working, and detect excess fluid in the pericardial sacBlood tests, which can detect if you have had or are having a heart attack, evaluate your heart’s function and how inflamed your pericardium is, and help determine the cause of your pericarditis
