Symptoms and Diagnosis of Pericarditis

Updated:Jul 7,2016

Symptoms of Pericarditis GraphicSigns and Symptoms of Pericarditis?

A common symptom of acute pericarditis is a sharp, stabbing chest pain, usually coming on quickly. It's often is 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 9–1–1 right away because you may be having a heart attack.

Fever is another common symptom of acute pericarditis. Other symptoms are weakness, trouble breathing, coughing and palpitations, which 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. In this type of pericarditis, chest pain is usually absent. 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 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 devlop. 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 doctor 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, a pediatric cardiologist or an infectious disease specialist may be involved, depending on the age and medical conditions of the patient. 

Medical History
Your doctor may ask whether you have had:

  • A recent respiratory infection or flu-like illness
  • A recent heart attack or injury to your chest
  • Any other medical conditions
If you have chest pain, your doctor 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 is inflamed, the fluid between the sac's two layers of tissue increases, so your doctor will look for signs of excess fluid in your chest. A common sign is the pericardial rub, the sound of the pericardium rubbing against the outer layer of your heart. Your doctor will listen for this by placing a stethoscope on your chest.

Your doctor 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
Your doctor may recommend tests to diagnose your condition and its severity. The most common tests are:
  • EKG (electrocardiogram). This detects and records your heart's electrical activity, with certain EKG results suggesting pericarditis.
  • Chest X-ray. A chest X-ray takes pictures of the inside of the chest, including your heart, lungs and blood vessels. The pictures can show whether you have an enlarged heart, which can be a sign of excess fluid in your pericardium.
  • Echocardiography. This test uses sound waves to create pictures of your heart, showing its size and shape and how well it's working. It can show whether fluid has built up in the pericardium.
  • Cardiac CT (computed tomography). This X-ray that takes a clear, detailed picture of your heart and pericardium and helps to rule out other causes of chest pain.
  • Cardiac MRI (magnetic resonance imaging).  A cardiac MRI uses magnets and radio waves to form detailed pictures of your organs and tissues. It can show changes in the pericardium.

    Your doctor also may recommend blood tests to find out whether you;ve had a heart attack, the cause of your pericarditis, and the extent of inflammation in your pericardium.


This content was last reviewed March 2016.

Also in this section: Learn more: Source: National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services

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