Acute Pericarditis

Acute pericarditis is an episode of inflammation of the pericardium, the thin, two-layered sac that surrounds the heart, that develops over hours to a few days. The inflamed layers become rough and rub against each other with every heartbeat. This causes a typical sharp chest pain: it gets worse when you breathe in, cough, or lie down, and eases when you sit up and lean forward.

Acute pericarditis is fairly common among patients who come to the emergency room with chest pain, but its symptoms resemble a heart attack. That is why new chest pain should never be self-diagnosed. An ECG and blood tests are needed to tell the two apart.

Common Causes

In most people, no cause is found and a viral infection is suspected. Acute pericarditis can also develop a few days to weeks after a heart attack, heart surgery, or a catheter procedure, as an inflammatory reaction of the body. Other causes include TB, bacterial infections, autoimmune diseases, kidney failure, and cancer. In Indonesia, TB needs to be considered, especially if symptoms develop gradually with fever, weight loss, or a long-lasting cough.

When a Hospital Stay Is Needed

Your doctor looks for high-risk signs before deciding on outpatient care. These include a fever above 38 degrees Celsius, symptoms that develop gradually over several days to weeks, a large amount of fluid in the heart sac, signs of pressure on the heart, and symptoms that do not improve after about one week of anti-inflammatory medicine. A raised troponin level, a weakened immune system, a chest injury, and the use of blood thinners are also taken into account. If any of these signs are present, a hospital stay and further investigation of the cause are recommended.

Treatment and Recovery

The main treatment is anti-inflammatory medicine, either aspirin or a nonsteroidal anti-inflammatory drug (NSAID), together with colchicine for about three months to lower the risk of recurrence. The anti-inflammatory medicine is tapered gradually based on your symptoms and CRP level. Strenuous exercise is postponed until symptoms are gone and inflammation markers are normal. Most patients recover with no lasting effects. If the inflammation also affects the heart muscle, a condition covered on the Myocarditis page, monitoring and the break from exercise are usually longer. If symptoms return after going away, the condition is covered on the Recurrent Pericarditis page.

Acute pericarditis is diagnosed when at least two of four signs are present: typical chest pain, a rubbing sound from the sac around the heart (pericardial friction rub), typical ECG changes, and new or increasing fluid in the heart sac. A raised CRP level or signs of inflammation on MRI or CT support the diagnosis.

The initial tests recommended for all patients are a physical examination, an ECG, echocardiography, a chest X-ray, and blood tests for inflammation markers and troponin. These tests also rule out a heart attack and other conditions that cause chest pain. In patients without high-risk signs who improve with medicine, a broad search for the cause is usually not needed. Tests for TB, autoimmune disease, or cancer are done if there are high-risk signs or clues pointing to a specific cause.

See a doctor if you have sharp chest pain that gets worse when you breathe in or lie down, especially after the flu or a digestive tract infection. New chest pain always needs to be checked because it can resemble a heart attack. If you are already being treated, contact your doctor if the pain does not improve after about one week, the fever does not go down, or you have side effects from the medicine such as stomach pain or severe diarrhea.

Go to the emergency room right away if you have:

• Severe or pressing chest pain, or chest pain with cold sweats
• Severe shortness of breath, or breathlessness that gets worse over a few hours
• Fainting or nearly fainting
• Pale, cold skin with a very fast heartbeat