What Are the Signs and Symptoms of Pericarditis?
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 left side of the chest. You also may feel pain in one or both shoulders.
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 9–1–1 right away, as you may be having a heart attack.
Fever is another common symptom of acute pericarditis. Other symptoms are weakness, palpitations, trouble breathing, and coughing. (Palpitations are feelings that your heart is skipping a beat, fluttering, or beating too hard or too fast.)
Chronic pericarditis often causes tiredness, coughing, and shortness of breath. Chest pain often is 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 if 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, which causes a sharp drop in blood pressure. If left untreated, cardiac tamponade can be fatal.
- Chronic constrictive pericarditis is a rare disease that develops over time. It leads to scar-like tissue forming 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 well.
How Is Pericarditis Diagnosed?
Your doctor will diagnose pericarditis based on your medical history, a physical exam, and the results from tests.
Primary care doctors—such as a family doctor, internist, or pediatrician—often diagnose and treat pericarditis. Other types of doctors also may be involved, such as a cardiologist, pediatric cardiologist, and an infectious disease specialist. A cardiologist treats adults who have heart problems. A pediatric cardiologist treats children who have heart problems. An infectious disease specialist treats people who have infections.
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
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.
Your doctor may recommend 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 your heart's electrical activity. Certain EKG results suggest pericarditis.
- Chest x ray. A chest x ray creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures 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. A cardiac 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. A cardiac MRI can show changes in the pericardium.
Your doctor also may recommend blood tests. These tests can help your doctor find out whether you've had a heart attack, the cause of your pericarditis, and how inflamed your pericardium is.