Chronic Pericarditis

Most cases of acute pericarditis settle within a few weeks. When inflammation of the sac around the heart lasts longer than three months, doctors call it chronic pericarditis. This term is different from incessant pericarditis, which is inflammation that continues for more than 4 to 6 weeks but less than three months, and from recurrent pericarditis, which is inflammation that returns after a symptom-free period, covered on the Recurrent Pericarditis page.

The symptoms of chronic pericarditis are often vaguer than those of an acute episode. Some people feel mild chest pain that comes and goes, tire easily, or are short of breath during activity. Others feel nothing at all and only find out from an echocardiogram that shows fluid in the heart sac.

Forms of Chronic Pericarditis

Long-lasting inflammation can take several forms. The effusive form is marked by fluid that persists in the heart sac, covered on the Pericardial Effusion page. The adhesive form is marked by adhesions and thickening of the sac without much fluid. When the sac becomes so thick and stiff that it restricts the filling of the heart, the condition has progressed to constriction, covered on the Constrictive Pericarditis page.

Why the Cause Needs to Be Found

Unlike an acute episode, where a cause is often not found, inflammation that lasts for months is more likely to have a specific cause. In Indonesia, TB should always be considered. Other causes include autoimmune diseases such as lupus and rheumatoid arthritis, severe kidney failure, an underactive thyroid gland, cancer, and past radiation to the chest. Treatment directed at the cause is often the key to settling the inflammation and the fluid.

Pericarditis caused by TB usually comes with fever, night sweats, weight loss, and a fairly large amount of fluid. If it is not fully treated, this inflammation can leave scar tissue that binds the heart. For this reason, testing of the pericardial fluid is sometimes needed to confirm the cause.

Living with Chronic Pericarditis

With the cause treated and regular monitoring, many people with chronic pericarditis can go about their usual activities. Strenuous exercise is postponed while the inflammation is still active. Regular checkups are still needed to detect increasing fluid or signs of constriction early, so treatment can be adjusted before symptoms get worse.

The diagnosis of chronic pericarditis rests on how long the inflammation has lasted and on evidence that it is still present, such as pain, a high CRP level, persistent fluid, or signs of inflammation on MRI. Echocardiography is the basic test to assess the fluid and the thickness of the sac, and it is repeated regularly.

The next step is to look for the cause. The doctor chooses tests based on your history and symptoms, such as a chest X-ray and TB tests, an ANA test for autoimmune disease, kidney function tests, and thyroid function tests. Cardiac CT or MRI assesses thickening, calcification, and active inflammation. If the cause is still unclear, the amount of fluid is large, or TB, a bacterial infection, or cancer is suspected, pericardial fluid can be drawn with a needle for testing. A pericardial biopsy is sometimes needed.

See a doctor if mild chest pain, tiring easily, or shortness of breath does not go away for months, especially if it comes with fever, night sweats, or weight loss. If you have already been diagnosed with chronic pericarditis, contact your doctor if shortness of breath or swelling increases, the pain becomes sharp again, or side effects from your medicines appear. Do not put off checkups just because your symptoms feel mild, because fluid can increase without many symptoms.

Go to the emergency room right away if you have:

• Severe shortness of breath or breathlessness that worsens quickly
• Fainting or nearly fainting
• Pale, cold, sweaty skin with a very fast heartbeat
• Swelling and a rapidly enlarging abdomen