Constrictive pericarditis and pericardial effusion

(Top) The pericardium has two layers. The outer, fibrous layer is tough and inelastic. The inner layer has two sheets separated by a thin film of lubricating fluid. (Left In constrictive pericarditis, inflammation scars the pericardium, causing it to thicken and shrink. The heart uscle is constricted and the heart may not be able to fill between contractions. (Right) In pericardial effusion, inflammation of the inner layers of the pericardium causes a build-up of fluid, which can compress the heart and interfere with its pumping

Pericarditis is a condition in which the membrane, or sac, around the heart is inflamed. This sac is called the pericardium.


The pericardium holds the heart in place and helps it work properly. The sac is made of two thin layers of tissue that enclose the heart. Between the two layers is a small amount of fluid. This fluid keeps the layers from rubbing against each other and causing friction.


In pericarditis, the layers of tissue become inflamed and can rub against the heart. This causes chest pain – a common symptom of pericarditis.


The chest pain from pericarditis may feel like pain from a heart attack. If you have chest pain, you should call emergency services right away, as you may be having a heart attack.



Many factors can cause pericarditis. Viruses and infections are common causes. Less often, pericarditis occurs after a heart attack or heart surgery. Lupus, scleroderma, rheumatoid arthritis, or other autoimmune disorders also can cause the condition. In about half of all cases, the cause is unknown.


Pericarditis can be acute or chronic. "Acute" means that it occurs suddenly and usually doesn't last long. "Chronic" means that it develops over time and may take longer to treat.


Both acute and chronic pericarditis can disrupt the heart's normal function and possibly (although rarely) lead to death. However, most cases of pericarditis are mild and clear up on their own or with rest and simple treatment. Other times, more intense treatment is needed to prevent complications. Treatment may include medicines and, less often, procedures and/or surgery.



It may take from a few days to weeks or even months to recover from pericarditis. With proper and prompt treatment, such as rest and ongoing care, most people fully recover from pericarditis. These measures also can help reduce the chances of getting the condition again.



The cause of about half of all pericarditis cases (both acute and chronic) is unknown.


Viral infections are likely the most common cause of acute pericarditis, but the virus may never be found. Pericarditis often occurs after a respiratory infection. Bacterial, fungal, and other infections also can cause pericarditis.


Less often, pericarditis is caused by:


  • Autoimmune disorders, such as lupus, scleroderma, and rheumatoid arthritis
  • Heart attack and heart surgery
  • Kidney failure, HIV/AIDS, cancer, tuberculosis, and other health problems
  • Injury from accidents or radiation therapy
  • Certain medicines, like phenytoin (an antiseizure medicine), warfarin and heparin (blood-thinning medicines), and procainamide (a medicine to treat abnormal heartbeats)

    The causes of acute and chronic pericarditis are the same.


    Who is at risk?

    Pericarditis occurs in people of all ages. However, men between the ages of 20 and 50 are more likely to get it.


    People who are treated for acute pericarditis may get it again. This may happen in 15 to 30 percent of people who have the condition. A small number of these people go on to develop chronic pericarditis.



    Signs and symptoms

    Sharp, stabbing chest pain is a common symptom of acute pericarditis. The pain usually comes on quickly. It often is felt in the middle or the left side of the chest.


    The pain tends to ease when you sit up and lean forward. Lying down and deep breathing worsens it. For some people, the pain feels like a dull ache or pressure in their chests.


    The chest pain may feel like pain from a heart attack. If you have chest pain, you should call 911 right away, as you may be having a heart attack.


    Fever is another common symptom of acute pericarditis. Other symptoms are weakness, trouble breathing, and coughing.


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


    Complications of pericarditis

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


    Cardiac tamponade occurs when too much fluid collects in the pericardium (the sac around the heart). The extra fluid puts pressure on the heart. This prevents the heart from properly filling with blood. As a result, less blood leaves the heart. This causes a sharp drop in blood pressure. If left untreated, cardiac tamponade can cause death.


    Chronic constrictive pericarditis is a rare disease that develops over time. It leads to scar-like tissue throughout the pericardium. The sac becomes stiff and can't move properly. In time, the scarred tissue compresses the heart and prevents it from working correctly.



    Your doctor will diagnose pericarditis based on your medical history and the results from a physical exam and tests.


    Specialists involved

    Primary care doctors – such as a family doctor, internist, or pediatrician – often diagnose and treat pericarditis. Other types of doctors also may be involved. These include a cardiologist, pediatric cardiologist, and an infectious disease specialist. A cardiologist treats people who have heart problems. An infectious disease specialist treats people who have infections.


    Medical history

    To learn more about your medical history, your doctor may ask whether you:


  • Have had a recent respiratory infection or flu-like illness
  • Have had a recent heart attack or injury to your chest
  • Have any other medical conditions

    Your doctor also may ask about your symptoms. If you have chest pain, he or she will ask you 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 (the sac around your heart) is inflamed, the amount of fluid between its two layers of tissue increases. As part of the exam, your doctor will look for signs of excess fluid in your chest.


    A common sign is the pericardial rub. This is the sound of the pericardium rubbing against the outer layer of your heart. Your doctor will place a stethoscope on your chest to listen for this sound.


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


    Diagnostic tests

    Your doctor may order one or more tests to diagnose your condition and show how severe it is. The most common tests are:


  • EKG (electrocardiogram). This simple test detects and records the electrical activity of your heart. Certain EKG results suggest pericarditis.

  • Chest X-ray. A chest X-ray takes pictures of your heart and lungs. The images can show whether you have an enlarged heart. This is a sign of excess fluid in your pericardium.

  • Echocardiography. This painless test uses sound waves to create pictures of your heart. The pictures show the size and shape of your heart and how well your heart is working. This test can show whether fluid has built up in the pericardium.

  • Cardiac CT (computed tomography). This is a type of X-ray that takes a clear, detailed picture of your heart and pericardium. CT helps rule out other causes of chest pain.

  • Cardiac MRI (magnetic resonance imaging). This test uses powerful magnets and radio waves to create detailed pictures of your organs and tissues. MRI can show changes in the pericardium.

    Your doctor also may order blood tests. These tests can help your doctor find out whether you've had a heart attack, the cause of the pericarditis, and how inflamed your pericardium is.



    Most cases of pericarditis are mild and clear up on their own or with rest and simple treatment. Other times, more intense treatment is needed to prevent complications. Treatment may include medicines and, less often, procedures and/or surgery.


    The goals of treatment are to:


  • Reduce pain and inflammation
  • Treat the underlying cause, if it's known
  • Check for complications

    Specific types of treatment

    As a first step in your treatment, your doctor may advise you to rest until you feel better and have no fever.


    He or she may tell you to take over-the-counter, anti-inflammatory medicines, such as aspirin or ibuprofen, to reduce pain and inflammation. You may need stronger medicine if your pain is severe.


    If your pain continues to be severe, your doctor may prescribe a medicine called colchicine and, possibly, prednisone (a steroid medicine).


    If an infection is causing your pericarditis, your doctor will prescribe an antibiotic or other appropriate medicine to treat the infection.


    You may need to stay in the hospital during treatment so your doctor can check you for complications.


    The symptoms of acute pericarditis can last from a few days to 3 weeks. Chronic cases may last several months.


    Other types of treatment

    If you have complications of pericarditis, you'll need treatment for those problems. Two serious complications of pericarditis are cardiac tamponade and chronic constrictive pericarditis.


    Cardiac tamponade is treated with a procedure called periocardiocentesis. A needle or tube (called a catheter) is inserted into the chest wall to remove excess fluid that has collected inside the pericardium. This relieves pressure on the heart.


    If time allows, the fluid may be removed with a special catheter or tube put through a small cut in the chest.


    The only cure for chronic constrictive pericarditis is surgery to remove the pericardium. This is known as a pericardiectomy.


    The treatments for these complications require hospital stays.



    You usually can't prevent acute pericarditis. But, you can take steps to reduce your chances of having another acute episode, having complications, or getting chronic pericarditis.


    These steps include getting prompt treatment, following your treatment plan, and having ongoing medical care (as your doctor advises).


    Living with pericarditis

    Many cases of pericarditis are mild and clear up on their own. But other cases, if not treated, can lead to chronic pericarditis and serious problems that affect your heart. Some problems can be life threatening.


    In some cases, it may take weeks or months to recover from a case of pericarditis. Full recovery is likely with rest and ongoing care. These measures also can help reduce the chances of having the condition again.