Table of ContentsView AllTable of ContentsChest PainFeverWeaknessTrouble BreathingCoughHeart PalpitationsOtherPossible ComplicationsChronic SymptomsDiagnosisWhen to See a Provider
Table of ContentsView All
View All
Table of Contents
Chest Pain
Fever
Weakness
Trouble Breathing
Cough
Heart Palpitations
Other
Possible Complications
Chronic Symptoms
Diagnosis
When to See a Provider
Pericarditisis a relatively common disease, accounting for around 5% of all causes of chest pain seen in the emergency room.The cardinal symptom of pericarditis is a sudden, sharp pain in the middle or left side of the chest that worsens when taking a deep breath and eases when leaning forward.
Because the symptoms of pericarditis mimic those of a heart attack and other life-threatening conditions, call 911 and be assessed in an emergency room when experiencing chest pains.
This article reviews the symptoms of pericarditis and possible complications, including recurrent episodes and what can happen if excess fluid builds up around the heart. It will also discuss how pericarditis is diagnosed and distinguished from more serious diagnoses like aheart attack.
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More than 95% of people with acute pericarditis experience sharp retrosternal (behind the breastbone) chest pain that comes on suddenly and worsens when taking in a deep breath.
Also, the chest pain associated with acute pericarditis tends to feel worse when lying down and improves in the seated position or when leaning forward.
Other chest pain features seen in pericarditis include:
Pericarditis is not generally considered a dangerous condition, and most people diagnosed with it recover well within a few weeks to months with prompt treatment and rest.
That said, its symptoms, namely chest pain, can mimic those seen with life-threatening conditions, such as:
As such, it’s crucial to seek emergency medical attention if you or a loved one is experiencing chest pain.
Is Sharp Pain in Your Chest Ever Not Serious?
Although less common than chest pain, fever is also a potential symptom of pericarditis.Fever develops when the temperature set point is altered in thehypothalamus, a gland deep within the brain.
Fever is also a symptom of pericarditis that develops after surgery on the heart that involves opening the pericardium—what’s known as postpericardiotomy syndrome.
Unfortunately, in a person with pericarditis, a temperature greater than 100.4 degrees F indicates a poorerprognosis(outcome) and reason for hospital admission for treatment.
Common Pericarditis Symptoms (and How Pericarditis Is Diagnosed)
Generalized weakness,malaise(feeling unwell), and fatigue are commonly seen in pericarditis.
Weakness in pericarditis may result from the inflamed pericardium itself, the underlying cause (e.g., a viral infection), or some combination.
Severe weakness and tiredness often develop if the pericarditis persists (e.g., chronic pericarditis) or impairs the heart’s ability to pump blood—a complication calledcardiac tamponade, discussed below.
Common Causes of Generalized Weakness
While dyspnea usually accompanies chest pain, research suggests that older females with pericarditis may experience problems breathing in the absence of chest discomfort.
As with weakness, cardiac tamponade can cause more severe breathing difficulties—termed respiratory distress.
A Note on Gender and Sex TerminologyVerywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
A Note on Gender and Sex Terminology
Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
A dry cough is another symptom of pericarditis, although it rarely occurs alone, without chest pain, fever, or trouble breathing.
Why Does My Chest Hurt When I Cough?
Heart palpitations, the sensation of a fluttering, irregular, or pounding heartbeat, are also possible symptoms of pericarditis.
Myocarditis is inflammation of the heart muscle and causes similar symptoms as pericarditis, although a subset of affected individuals present with life-threateningheart arrhythmiaandheart failure.
Depending on the cause of the pericarditis, other symptoms may be present.
For example, a person with pericarditis from a viral infection may also experience muscle aches, sore throat, runny nose, or diarrhea.
Weight loss may also occur with pericarditis related to cancer or a bacterial infection, especiallytuberculosis.
Hiccupsor trouble swallowing (dysphagia) have been reported in acute pericarditis. These symptoms are thought to arise from irritated or compressed structures located near a swollen, fluid-filled pericardium.
Possible Complications of Pericarditis
A rare but life-threatening complication of pericarditis is cardiac tamponade, which occurs when excess fluid buildup within the pericardium, calledpericardial effusion, squeezes the heart muscle, preventing it from pumping blood effectively.
Three classic signs of cardiac tamponade are:
Cardiac tamponade requires immediate fluid drainage through a procedure called apericardiocentesis.
What Is Pericardiocentesis?A pericardiocentesis usually involves using a thin needle and tube (catheter) to remove fluid around the heart to restore its function. An operation to open the chest is less commonly performed to remove the fluid.
What Is Pericardiocentesis?
A pericardiocentesis usually involves using a thin needle and tube (catheter) to remove fluid around the heart to restore its function. An operation to open the chest is less commonly performed to remove the fluid.
Other complications of pericarditis are:
Symptoms of Chronic Pericarditis
An estimated 15% to 30% of individuals with acute pericarditis will experience recurrent or chronic pericarditis.
With recurrent pericarditis, symptoms resemble those of acute pericarditis but tend to be less severe.
Symptoms of chronic pericarditis include tiredness, coughing, and shortness of breath. Chest pain may or may not be present.
Key symptoms and signs of constrictive pericarditis—a severe form of chronic pericarditis—include:
How Pericarditis Is Diagnosed
When diagnosing pericarditis, a healthcare provider will consider a person’s symptoms, physical exam findings, and results from various diagnostic tests.
Medical History
During a medical history, in addition to inquiring about symptoms, including the duration, severity, quality, and location of the chest pain, a healthcare provider will ask about medication use and history of health conditions, such as a recent viral infection.
Physical Exam
Next, they will perform a physical examination, starting with takingvital signs(temperature, heart rate, blood pressure, breathing rate) and listening to their heartbeat with a stethoscope.
The presence of a pericardial friction rub on the heart exam is a highly specific finding for pericarditis.
What Is a Pericardial Friction Rub?
Diagnostic Tests
After a physical exam, a person will undergo anelectrocardiogram (ECG). The ECG measures the heart’s electrical activity and is crucial for ruling out potentially life-threatening conditions that mimic pericarditis, like a heart attack.
An ECG classically shows widespread concave “saddle-shaped” ST elevation in acute pericarditis. The ST segment represents the time between when the heart’s ventricles contract and recover.
Additional diagnostic tests for pericarditis include:
Sometimes,cardiaccomputed tomography(CT) orcardiac magnetic resonance (CMR)imaging may be ordered, mainly if other tests are inconclusive or symptoms are atypical. They can support a diagnosis of pericarditis, including constrictive pericarditis.
When to Contact a Healthcare Provider
If you are experiencing any chest pain, call 911 right away, as the pain may be a sign of a heart attack.
Also, contact your healthcare provider if you are being treated for pericarditis and your symptoms are worsening or persisting or you develop new symptoms like swelling, trouble breathing, or heart palpitations.
Summary
Pericarditis is inflammation of the pericardium, the protective tissue that encloses the heart muscle. The primary symptom of pericarditis is a sudden, sharp pain in the middle or left side of the chest. This pain worsens when taking a deep breath and lessens when leaning forward.
Other common symptoms are fever, generalized weakness, trouble breathing, abnormal heart sensations (palpitations), and cough.
The most severe complication of acute pericarditis is cardiac tamponade—a medical emergency that arises when extra fluid inside the pericardium squeezes the heart muscle, impairing its function. Additional complications include recurrent episodes of pericarditis or, rarely, scar tissue formation within the pericardium (constrictive pericarditis).
With proper treatment and rest, most people with acute pericarditis recover well without complications. However, since symptoms of pericarditis resemble those of a heart attack, emergency medical attention is warranted to sort out the correct diagnosis.
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Snyder MJ, Bepko J, White M.Acute pericarditis: diagnosis and management.Am Fam Physician. 2014;89(7):553-560.
Awan A, Tiruneh F, Wessly P, et al.Acute pericarditis: descriptive study and etiology determination in a predominantly African American population.Cureus. 2017;9(7):e1431. doi:10.7759/cureus.1431
Smid J, Scherner M, Wolfram O, Groscheck T, Wippermann J, Braun-Dullaeus RC.Cardiogenic causes of fever.Dtsch Arztebl Int. 2018;115(12):193-199. doi:10.3238/arztebl.2018.0193
Imazio M, Gaita F, LeWinter M.Evaluation and treatment of pericarditis: a systematic review.JAMA. 2015;314(14):1498-1506. doi:10.1001/jama.2015.12763
Lazaros G, Antonopoulos AS, Lazarou E, et al.Age- and sex-based differences in patients with acute pericarditis.Eur J Clin Invest. 2021;51(3):e13392. doi:10.1111/eci.13392
Fong HK, Abdullah O, Gautam S.Cough as the sole manifestation of pericardial effusion.BMJ Case Rep. 2018;2018:bcr2017222327. doi:10.1136/bcr-2017-222327
Andrani F, Aiello M, Bertorelli G, Crisafulli E, Chetta A.Cough, a vital reflex. mechanisms, determinants and measurements.Acta Biomed. 2019;89(4):477-480. doi:10.23750/abm.v89i4.6182
Brociek E, Tymińska A, Giordani AS, et al.Myocarditis: etiology, pathogenesis, and their implications in clinical practice.Biology (Basel). 2023;12(6):874. doi:10.3390/biology12060874
Ismail TF.Acute pericarditis: update on diagnosis and management.Clin Med (Lond). 2020;20(1):48-51. doi:10.7861/clinmed.cme.20.1.4
Adler Y, Ristić AD, Imazio M, et al.Cardiac tamponade.Nat Rev Dis Primers. 2023;9(1):36. doi:10.1038/s41572-023-00446-1
Chiabrando JG, Bonaventura A, Vecchié A, et al.Management of acute and recurrent pericarditis: JACC state-of-the-art review.J Am Coll Cardiol. 2020;75(1):76-92. doi:10.1016/j.jacc.2019.11.021
Vecchiè A, Dell M, Mbualungu J, Ho AC, VAN Tassell B, Abbate A.Recurrent pericarditis: an update on diagnosis and management.Panminerva Med. 2021;63(3):261-269. doi:10.23736/S0031-0808.21.04210-5
American Heart Association.Symptoms and diagnosis of pericarditis.
Miranda WR, Oh JK.Constrictive pericarditis: a practical clinical approach.Prog Cardiovasc Dis. 2017;59(4):369-379. doi:10.1016/j.pcad.2016.12.008
Ibrahim O, Sibbald M, Szczeklik W, Leśniak W.Pericardial friction rub. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna
Yamani N, Abbasi A, Almas T, Mookadam F, Unzek S.Diagnosis, treatment, and management of pericardial effusion- review.Ann Med Surg (Lond). 2022;80:104142. doi:10.1016/j.amsu.2022.104142
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