Pericarditis: sharp chest pain, causes, tests and treatment explained

Chest pain has many causes, and one of them is swelling around the heart. This article explains pericarditis, how it is recognised and treated, and why any new chest pain needs medical advice. It draws on the NHS and MedlinePlus.

1. Introduction

The pericardium is a thin sac, filled with a little fluid, that surrounds the heart. Pericarditis means this sac is inflamed, which is swelling and irritation ^{[1, 2]}. The NHS says it is usually not serious but can sometimes lead to serious health problems, and that blood or fluid can leak into the sac ^[1]. MedlinePlus describes two related problems: pericardial effusion, which is a build-up of fluid in the sac, and cardiac tamponade, a serious condition in which the fluid stops the heart from working properly ^[3].

2. Signs and symptoms

The main symptom is chest pain. The NHS describes it as usually sharp or stabbing, and it may spread to the shoulders, arms or tummy ^[1]. Typical features include ^{[1, 2]}:

• Pain that gets worse with deep breaths, swallowing, coughing or lying down, especially on the left side
• Pain that eases when you sit up and lean forward
• A fever, or feeling hot, cold or shivery
• A dry cough and painful joints

MedlinePlus also lists leg or ankle swelling, tiredness, anxiety and trouble breathing when lying down ^[2]. A fast heartbeat can occur too, and MedlinePlus says fever is a common symptom of acute pericarditis ^[3].

3. Causes and risk factors

The exact cause is often hard to confirm, but the NHS says it is usually a viral infection, such as a cold or flu ^[1]. MedlinePlus explains that other causes include bacterial infections, heart attack, heart surgery, chest injury, chest radiation therapy and some medicines ^{[2, 3]}. It is linked with conditions such as autoimmune diseases, an underactive thyroid, kidney failure and tuberculosis ^[2]. It is most often seen in men aged 20 to 50, and MedlinePlus says the cause is often unknown ^[2].

4. Diagnosis and tests

A doctor will listen to your heart, because pericarditis can change the sounds. MedlinePlus says a friction (rubbing) sound may be heard and heart sounds may seem muffled ^[2]. To confirm the diagnosis the NHS says a doctor may arrange ^[1]:

• Blood tests
• A chest X-ray
• An electrocardiogram (ECG), which records the electrical activity of the heart. The NHS says an ECG is painless and some GP surgeries can do one ^[1]
• An echocardiogram, which is an ultrasound scan of the heart

MedlinePlus adds that heart MRI or CT scans, and blood tests for heart muscle damage, inflammation or infection, may be used ^[2].

5. Treatment and recovery

Treatment depends on the cause ^{[1, 3]}. The NHS says anti-inflammatory painkillers are commonly used to relieve the pain, and that sitting up or leaning forward can ease the pain. If these do not work or the problem returns, a doctor may prescribe a medicine called colchicine, and steroids may be considered if that is not enough. Antibiotics are used if a bacterial infection is the cause ^[1]. MedlinePlus says antifungal medicines treat fungal causes ^[2].

If a lot of fluid collects and affects the heart, doctors can drain it with a needle procedure. In persistent or repeated cases, surgery on the sac may be needed ^[2]. MedlinePlus says pericarditis is usually not life-threatening but can be dangerous without treatment ^[2]. Medicines should only be taken as your doctor advises.

The NHS says most people improve within a few weeks ^[1]. MedlinePlus gives a range of about 2 weeks to 3 months with prompt treatment. It warns that the condition can return and that severe cases may lead to scarring and thickening of the sac, called constrictive pericarditis, which can resemble heart failure ^[2].

6. Prevention

MedlinePlus says many cases cannot be prevented ^[2]. The NHS says anyone with chest pain should get medical advice ^[1].

Keeping a short record can help at your appointment. Note when the pain began, what makes it better or worse, and whether you had a cold, flu or other illness before it started, since the NHS says pericarditis often follows a viral infection ^[1]. Tell the doctor about every medicine you take, because MedlinePlus says some medicines can cause pericarditis ^[2]. Ask your doctor when it is safe to return to your usual activities. If the pain comes back after you have felt better, contact your doctor again, because MedlinePlus says pericarditis can recur ^[2]. Do not take extra painkillers beyond your doctor's instructions.

7. When to see a doctor

See a doctor urgently if you have sharp chest pain that gets worse when you breathe in deeply, swallow, cough or lie down ^[1]. The NHS advises calling emergency services for sudden chest pain that spreads to the arms, back, neck or jaw, feels tight or heavy, comes with breathlessness, sweating or sickness, or lasts more than 15 minutes, because it could be a heart attack. Do not drive yourself to hospital ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Pericarditis is swelling of the sac around the heart. It often follows a viral illness and most people improve within weeks to months with the right care. Because chest pain can be a sign of a heart attack, anyone with chest pain should get medical advice. Your doctor will decide which tests and treatment are right for you.