What Is Pericarditis? Know the Symptoms, Causes, and Complications

Feeling a sharp chest pain is understandably very worrying, especially when the pain feels like a heart attack. In fact, this complaint can also be a sign of pericarditis, inflammation of the thin sac that surrounds the heart (pericardium).

The early symptoms of pericarditis are often confusing. The chest pain usually gets worse when lying down and feels lighter when sitting up or leaning forward. Because it resembles a heart attack, this condition needs to be recognized carefully so that getting medical treatment is not delayed.

Why Is This Information Important?

Many people dismiss chest pain as just “masuk angin” (a common Indonesian term for feeling unwell with bloating, chills, and body aches) or fatigue. However, pericarditis can develop into serious complications, such as life-threatening cardiac tamponade.

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What Is Pericarditis?

Pericarditis is inflammation of the pericardium, the thin sac that covers the heart. This sac consists of two membranes with a small amount of fluid between them that acts as a lubricant.

The pericardium plays an important role in:

• Protecting the heart from infection and injury,
• Keeping the heart in a stable position in the chest cavity,
• Reducing friction as the heart beats,
• Controlling how much the heart stretches when blood volume increases suddenly

Acute vs. Chronic Pericarditis

Pericarditis can be:

• Acute: it appears suddenly and usually lasts for a few weeks.
• Chronic: it lasts more than 3 months and can affect heart function in the long term.

In addition, some patients experience recurrent pericarditis (relapsing), which can come back after the initial symptoms have improved.

Who Is Most Often Affected?

Although anyone can develop it, research shows that men aged 20 to 50 get pericarditis more often than other groups.

Other risk factors that can increase the chance of developing pericarditis are discussed in more detail in the section on causes.

How It Differs From Myocarditis

It is important to distinguish pericarditis from myocarditis (inflammation of the heart muscle).

• In pericarditis, the characteristic chest pain often improves when sitting up and leaning forward.
• In myocarditis, the complaints are more often shortness of breath, fatigue, or impaired heart pumping function

To learn more, please also read our article on myocarditis.

Now that you understand what pericarditis is, let’s look at the typical symptoms of pericarditis that are important to recognize early.

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Symptoms of Pericarditis

Characteristic Chest Pain

The most common symptom of pericarditis is sharp chest pain. This pain usually:

• Gets worse when lying down or taking a deep breath,
• Improves when sitting up or leaning forward.

These characteristics of pericarditis chest pain are different from a heart attack, so it is important to recognize them early.

Additional Symptoms That Often Appear

Besides pericarditis chest pain, people with the condition may also experience:

• Shortness of breath, especially when lying flat;
• Mild fever, usually due to inflammation or an accompanying infection;
• Palpitations (a fast or irregular heartbeat);
• Fatigue, a general feeling of weakness due to the body’s inflammatory process.

Symptoms Similar to a Heart Attack: How Can You Tell the Difference?

In fact, pericarditis symptoms often resemble a heart attack. However, there are some important differences:

Factor	Pericarditis Chest Pain	Heart Attack Chest Pain
Nature of the pain	Sharp, pleuritic (related to breathing)	Heavy, like pressing or crushing
Body position	Worse when lying down, better when sitting up and leaning forward	Not affected by position
Pain radiation	May spread to the shoulder or back	Often spreads to the left arm, jaw, neck
Accompanying symptoms	Mild fever, cough, palpitations, fatigue	Cold sweats, nausea, dizziness, fainting

Conclusion: although the symptoms can be misleading, these small differences can help doctors distinguish pericarditis chest pain from heart attack chest pain.

After understanding the symptoms of pericarditis, the next step is to recognize the causes of pericarditis. This way, you can better understand the triggers behind this condition and how to prevent it.

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Causes of Pericarditis

Pericarditis is caused by inflammation of the heart’s lining (pericardium). This condition can arise from infection, autoimmune disease, complications after heart problems, trauma, or medication side effects. However, in many cases, the cause remains unknown (idiopathic).

1. Infection: Viruses, Bacteria, and Fungi

Infection is one of the most common causes of pericarditis.

• Viruses: Coxsackie, influenza, and even SARS-CoV-2 (COVID-19) are often reported to trigger inflammation of the pericardium.
• Bacteria: tuberculosis (TB) is still an important factor in Indonesia.
• Fungi: less common, but can occur in people with a weakened immune system.

2. Autoimmune Diseases

Autoimmune disorders cause the immune system to attack the body’s own tissues, including the pericardium. Examples include:

• Lupus
• Rheumatoid arthritis
• Scleroderma

These conditions usually require long-term therapy to control the inflammation.

3. Complications After a Heart Attack or Heart Surgery

Pericarditis can be caused by the body’s response after a heart attack or a major heart procedure, such as bypass surgery or pacemaker implantation. A syndrome known as Dressler syndrome can appear a few weeks after a heart attack as a result of an autoimmune reaction.

4. Chest Trauma

A direct injury to the chest, for example from an accident or a hard impact, can also cause inflammation of the pericardium.

5. Side Effects of Certain Medications

Some heart medications and antibiotics can, in rare cases, cause pericarditis as a side effect. Examples include:

• Hydralazine
• Procainamide
• Isoniazid

Although this is rare, doctors usually review a patient’s medication history if this cause is suspected.

6. Idiopathic (Unknown Cause)

In most cases, especially in developed countries, the cause of pericarditis cannot be determined even after a complete workup. This is called idiopathic, and it is usually treated symptomatically according to its severity.

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Types of Pericarditis

Pericarditis can be divided into several types based on duration, symptoms, and its impact on the heart. Understanding these differences is important for choosing the right therapy and preventing complications.

1. Acute Pericarditis

• Symptoms appear suddenly and last less than 6 weeks.
• It usually improves with anti-inflammatory medication and rest.
• It is the most common form.

2. Chronic / Subacute Pericarditis

• If symptoms last more than 3 months, the condition is called chronic.
• It often starts from acute pericarditis that did not fully heal.

3. Recurrent Pericarditis

• Symptoms return after the patient has been well for at least 4 to 6 weeks.
• It is estimated to occur in 15 to 30% of patients, so long-term monitoring is needed.

4. Constrictive Pericarditis

• The pericardium becomes thick and stiff, so the heart has difficulty pumping blood optimally.
• Symptoms resemble heart failure: shortness of breath, swelling of the legs or abdomen, tiring easily.
• In severe cases, surgery called pericardiectomy may be needed.

5. Pericardial Effusion & Effusive-Constrictive Pericarditis

• This occurs when excess fluid builds up in the pericardial space.
• If the fluid presses on the heart, it can lead to cardiac tamponade, a medical emergency.
• It is sometimes accompanied by constriction, in which case it is called effusive-constrictive pericarditis.

Each type of pericarditis carries different risks. If not treated properly, some can develop into more serious conditions, such as tamponade or permanent constrictive pericarditis. That is why it is important to understand the complications of pericarditis, which are discussed in the next section.

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Complications of Pericarditis

Complications of pericarditis can range from mild conditions to life-threatening medical emergencies. Understanding these risks is very important so that patients and their families stay alert and seek medical help right away if symptoms get worse.

1. Cardiac Tamponade

One of the most serious complications of pericarditis is cardiac tamponade. This condition occurs when fluid builds up in the pericardial space and puts excessive pressure on the heart. This pressure prevents the heart chambers from filling with blood normally, so the heart’s pumping function is impaired. As a result, the patient may experience a drastic drop in blood pressure, shortness of breath, and even shock. Cardiac tamponade is a medical emergency that requires immediate action, usually a procedure called pericardiocentesis to remove the fluid around the heart.

2. Constrictive Pericarditis

Another complication is constrictive pericarditis, a condition in which the pericardium thickens, hardens, and loses its elasticity. As a result, the heart cannot expand properly as it fills with blood. Patients usually complain of shortness of breath, fatigue, and swelling in the legs or abdomen. In Indonesia, fairly common causes are tuberculosis or side effects of radiotherapy. When it becomes severe, constrictive pericarditis can cause symptoms similar to heart failure and often requires a pericardiectomy, the surgical removal of the stiff pericardium.

3. Risk of Heart Failure

In addition to the two complications above, pericarditis can also increase the risk of heart failure. A large buildup of fluid (pericardial effusion) or constrictive pericarditis can put chronic pressure on the heart. Over a long period, this weakens the heart’s pumping function and leads to symptoms of heart failure, such as severe fatigue, shortness of breath during light activity, and even swelling of the legs and ankles. That is why early detection and appropriate treatment are key to preventing the condition from getting worse.

When Should You See a Doctor Right Away?

Patients with pericarditis need to seek medical help immediately if they experience sudden and severe chest pain, shortness of breath that worsens quickly, or sudden fainting. These symptoms can be signs of cardiac tamponade or acute heart failure, two conditions that require immediate medical intervention to save a life.

Because complications of pericarditis can be fatal, a prompt and accurate diagnosis is very important. In the next section, we will discuss how doctors make a diagnosis of pericarditis through a physical examination, supporting tests, and current medical technology.

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Diagnosing Pericarditis

Diagnosing pericarditis requires a combination of clinical examination, supporting tests, and imaging to confirm the condition accurately. The goal is to make the diagnosis early, distinguish it from other heart diseases such as a heart attack, and determine the most suitable therapy.

1. Physical Examination

The first step is auscultation with a stethoscope. Doctors often hear a characteristic sound called a pericardial friction rub, a rubbing sound caused by the inflamed pericardium. This sound is heard most clearly when the patient sits leaning forward and holds their breath. The presence of a friction rub is highly specific for diagnosing pericarditis.

2. ECG (Electrocardiogram)

An ECG is a key test in diagnosing pericarditis. The typical pattern often includes widespread ST-segment elevation across many leads and PR-segment depression. This distinguishes it from a myocardial infarction, which generally shows more localized changes.

3. Echocardiography (Heart Ultrasound)

Transthoracic echocardiography (TTE) is used to detect fluid in the pericardial space (pericardial effusion) and to assess overall heart function. This test also helps identify dangerous complications such as cardiac tamponade.

4. Chest X-Ray, CT Scan, and MRI

• A chest X-ray can show an enlarged heart shadow due to fluid buildup.
• A CT scan helps detect thickening or calcification of the pericardium.
• Cardiac MRI is better at assessing active inflammation and scar tissue in the pericardium, while also distinguishing it from other heart diseases.

5. Blood Tests

Laboratory tests include:

• CRP and the erythrocyte sedimentation rate (ESR) to look for signs of inflammation.
• Troponin to evaluate whether the heart muscle is involved (myopericarditis).
• A complete blood count (CBC) to look for a possible infectious cause.

These test results complement the clinical picture from the physical examination and imaging.

Clinical Diagnostic Criteria

According to international medical guidelines, acute pericarditis can be diagnosed when at least two of the following four criteria are met:

1. Characteristic chest pain that gets worse when lying down.
2. A friction rub is heard.
3. Characteristic changes on the ECG.
4. Evidence of pericardial effusion on echocardiography.

Why Is Accurate Diagnosis Important?

An accurate diagnosis of pericarditis helps doctors choose therapy early, reduce the risk of serious complications, and prevent recurrence. In fact, the sooner pericarditis is diagnosed, the better the patient’s prognosis for recovering without long-term problems.

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Treating Pericarditis

Treatment of pericarditis depends on its severity, the underlying cause, and the patient’s overall health. In many cases, pericarditis can heal with simple therapy such as anti-inflammatory medication and rest. However, more serious cases require additional medication, medical procedures, or even surgery to prevent dangerous complications.

Treatment for Mild Pericarditis

For mild pericarditis, doctors usually prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin. These medications help reduce inflammation of the heart’s lining while also relieving chest pain. In addition, patients are advised to get enough rest, avoid strenuous physical activity, and monitor their symptoms regularly.

Most patients with acute pericarditis can recover fully with anti-inflammatory medication and a healthy lifestyle alone.

Therapy for More Severe Pericarditis

If symptoms do not improve with NSAIDs, the doctor may prescribe colchicine. This medication is effective at suppressing inflammation and preventing recurrence (recurrent pericarditis). In certain cases, corticosteroids may be given to control more severe inflammation, especially when it is caused by an autoimmune disease.

In addition, if pericarditis is triggered by a bacterial infection, antibiotic therapy must be given so that the infection does not spread and damage heart tissue.

Fluid Drainage (Pericardiocentesis)

In emergencies such as cardiac tamponade, when fluid builds up and presses on the heart, the doctor will perform a procedure called pericardiocentesis. Using a special needle or catheter, the pericardial fluid is drawn out to relieve the pressure. This procedure is performed in a hospital under close supervision, often guided by echocardiography or fluoroscopy to improve safety.

Surgery (Pericardiectomy) for Constrictive Pericarditis

If pericarditis becomes constrictive, the pericardium can thicken and harden so that the heart has difficulty expanding. In this case, surgery to remove the heart’s lining (pericardiectomy) becomes the main option. This procedure aims to restore heart function and prevent chronic heart failure caused by a stiff pericardium.

Prognosis and Outlook for Patients

With appropriate therapy, the prognosis of pericarditis is generally very good. Most patients can recover fully without long-term complications. However, it is important for patients to follow their treatment plan consistently and have regular check-ups with a cardiologist. This is to make sure the inflammation has truly resolved and to prevent it from coming back in the future.

In fact, prevention and self-management play a major role in keeping the heart healthy. Therefore, once symptoms improve, patients need to understand the appropriate prevention and self-care steps to protect their heart.

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Prevention and Self-Care

Preventing pericarditis is not always fully possible, because some cases are linked to viral infections or other medical conditions that are hard to avoid. However, there are steps that can help lower the risk of recurrence and keep the heart healthy overall.

1. Treat infections promptly: viral and bacterial infections are among the most common triggers of pericarditis. That is why treating infections early is very important. For example, do not ignore a high fever, a prolonged cough, or a severe sore throat. Seeing a doctor promptly can keep an infection from getting worse and reduce the risk of inflammation of the pericardium.
2. Control autoimmune diseases: some autoimmune diseases, such as lupus or rheumatoid arthritis, can trigger inflammation of the heart’s lining. Controlling these conditions through regular treatment and periodic check-ups helps reduce the risk of repeated pericarditis. Patients are advised to always follow the treatment plan given by their internal medicine specialist or rheumatologist.
3. Avoid strenuous exercise while symptoms are active: physical activity that is too strenuous can make pericarditis symptoms worse. While you still have chest pain or shortness of breath, avoid intense exercise such as long-distance running or heavy weightlifting. Instead, choose light activities such as relaxed walking once your doctor says your condition is more stable.
4. Follow a heart-healthy lifestyle: a heart-healthy lifestyle also plays an important role in preventing pericarditis and other cardiovascular diseases. Some recommended steps include:
   • Eating a balanced, nutritious diet rich in fruits, vegetables, fish, and whole grains.
   • Getting enough sleep every night to support the body’s recovery.
   • Managing stress with relaxation techniques, prayer, or meditation.
   • Avoiding cigarettes and alcohol, which can worsen heart conditions.

All of these steps not only protect the heart from inflammation, but also improve long-term quality of life.

However, even though preventive steps are very helpful, there are times when certain symptoms need immediate medical attention.

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When Should You See a Doctor?

Knowing when to see a doctor for pericarditis is very important, because some of its symptoms can resemble other serious heart conditions, including a heart attack. The sooner a patient gets medical help, the greater the chance of preventing dangerous complications.

1. Sudden chest pain or shortness of breath: see a doctor right away if you experience sharp chest pain that feels stabbing, or shortness of breath that comes on suddenly. These symptoms can signal acute pericarditis or an emergency such as cardiac tamponade. Prompt medical treatment can save a life.
2. If the symptoms resemble a heart attack: in fact, pericarditis often causes complaints similar to a heart attack: chest pain spreading to the shoulder or arm, palpitations, and even cold sweats. Because these are hard to tell apart without a medical examination, do not delay going to the emergency department (ER). An evaluation with an ECG and supporting tests is needed right away to distinguish pericarditis from a heart attack.
3. If symptoms return after a previous diagnosis: if you have been diagnosed with pericarditis before and symptoms come back, such as unusual chest pain or shortness of breath, consult a doctor right away. A recurrence can signal recurrent pericarditis or a further complication such as constrictive pericarditis.

Consult a Cardiologist

Pericarditis is not a condition to take lightly. An accurate diagnosis and appropriate therapy play a major role in a successful recovery. Schedule a consultation with a Heartology cardiologist for further evaluation.

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Conclusion

Pericarditis is inflammation of the heart’s lining (pericardium) that can generally heal completely when treated promptly and appropriately. Although some cases are mild, this condition should not be underestimated because it can cause serious complications if medical care is delayed.

In addition, recognizing the symptoms of pericarditis early is very important. Sharp chest pain that gets worse when taking a deep breath, shortness of breath, or a pounding heartbeat should be taken seriously right away. In fact, these symptoms often resemble a heart attack. That is why a medical examination is a crucial step to confirm the correct diagnosis and distinguish it from other dangerous heart conditions.

For this reason, consult a cardiologist promptly if you notice suspicious symptoms. An accurate diagnosis will help determine the cause of pericarditis and ensure the most appropriate therapy, ranging from anti-inflammatory medication and additional treatment to medical procedures when needed.

At Heartology Cardiovascular Hospital, cardiologists can help evaluate chest pain and complaints that point to pericarditis through tests such as an ECG, echocardiography, and blood tests.