Pericarditis Chest Pain: Symptoms, Causes and When to Get Help

What it involves

MedlinePlus explains that pericarditis is a condition in which the sac-like covering around the heart, called the pericardium, becomes inflamed. In many cases the cause is unknown or unproven. It mostly affects men ages 20 to 50, and it can range from a mild illness that gets better on its own to a life-threatening condition.

Who this is for

• Adults recovering from a viral illness who notice sharp chest pain with breathing.
• Patients who were told in an emergency room that their chest pain was pericarditis and need follow-up.
• People with autoimmune disease, kidney failure or a past heart surgery who want to understand the risks.
• Anyone whose pain returns after treatment and who wants a plan.

What to expect

• Questions about the pain, what makes it better or worse, recent infections, fever and your medicines
• A heart and lung exam, and blood work, which the practice offers, to look for inflammation
• An EKG at the Loxahatchee and West Palm Beach offices, and a referral for an echocardiogram or imaging when needed
• A referral to a cardiologist when the cause is unclear, the pain keeps returning or fluid is suspected

Call 911 first for chest pain

Nobody can tell pericarditis from a heart attack by how it feels. Chest pressure or pain with sweating, shortness of breath, nausea, or pain spreading to the arm or jaw needs emergency care, as the chest pain guide explains. Fainting, a racing heartbeat or trouble breathing when lying down also call for the ER. Only after emergency causes are ruled out is a clinic visit the right place to sort out the rest. Women can have different warning signs, described in the heart attack in women guide.

What it can feel like

The encyclopedia describes chest pain that is almost always present, sharp and stabbing, and often worse with deep breathing, coughing, swallowing and lying flat. It is often relieved by sitting up and leaning or bending forward. Fever, chills or sweating can appear when an infection is the cause. Other symptoms include a dry cough, fatigue, anxiety, trouble breathing when lying down, and swelling in the ankles, feet and legs. Pain made worse by each breath can also come from the lining of the lungs, which the pleurisy guide describes.

Common causes

MedlinePlus says pericarditis is often the result of an infection, most often a viral illness such as a chest cold, and less often bacterial or fungal infection. It can be seen with autoimmune diseases, cancer, HIV infection, an underactive thyroid, kidney failure, rheumatic fever and tuberculosis. Heart attack, heart surgery or chest trauma, certain medicines, inflammation of the heart muscle and radiation to the chest can also be behind it. In many people no cause is found. The thyroid blood tests page and the kidney function tests page explain two of the checks.

How it is evaluated

A provider listens to the heart, since MedlinePlus says a scratchy sound called a pericardial rub can sometimes be heard, and heart sounds may be muffled when fluid has built up. Tests the encyclopedia lists include an electrocardiogram, chest x-ray, echocardiogram, heart MRI or CT, and blood tests for inflammation, infection and heart muscle damage. The practice offers blood work and an EKG at the Loxahatchee and West Palm Beach offices. Imaging and echocardiograms are arranged by referral. The heart palpitations guide covers rhythm symptoms.

Treatment and recovery

According to the encyclopedia, the cause should be identified if possible. High doses of anti-inflammatory medicines such as ibuprofen are often given with a medicine called colchicine, taken for days to weeks or longer, and other medicines are used when an infection or fluid is involved. Fluid that interferes with the heart can need draining in a hospital. MedlinePlus says most people recover in 2 weeks to 3 months, though pericarditis may come back. Never start or stop these medicines without medical advice.

Follow-up in primary care

After an emergency visit, a primary care provider can review your discharge papers, check that the pain is easing and look at blood pressure, kidney function and thyroid tests that bear on the cause. Swelling in the legs along with shortness of breath is also worth discussing, as the leg swelling guide and the heart failure management page explain. If symptoms return, treat them as new and call 911 for severe pain. Same-day visits and walk-ins are welcome for follow-up.

Sources

• MedlinePlus: Pericarditis (encyclopedia)