What You Should Know About Acute Pericarditis

Am Fam Physician. 2014;89(7):online

See related article on acute pericarditis

What is acute pericarditis?

Acute pericarditis (PAIR-ih-kar-DI-tiss) is an inflammation of the sac around the heart, which is called the pericardium (PAIR-ih-KAR-dee-um). It usually happens in men 20 to 50 years of age, but it can happen in anyone.

How do you get it?

Usually it is caused by a virus. It can also be caused by a heart attack, a tear in the heart, or another disease. Other possible causes are cancer or a reaction to a medicine you have taken. Many times the cause is not known.

What are the symptoms?

Most patients have chest pain. The pain can spread to your jaw and arm, which may feel like a heart attack. This pain may get worse when you lie on your back, cough, or take a deep breath. It usually gets better when you sit and lean forward. Some people never have any chest pain.

How is it diagnosed?

Your doctor will ask about the pain, listen to your heart, and check for signs of fluid around your heart. He or she may order a test called an electrocardiogram, which shows the electrical activity of your heart. You may need more tests, such as a chest x-ray, an ultrasound of your heart, and blood tests.

How is it treated?

It is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (one brand: Motrin), or another medicine called colchicine. Colchicine can help if you have already been diagnosed with acute pericarditis, or if your symptoms do not get better with NSAIDs. This medicine should be taken until your symptoms go away.

What can I expect?

Most patients get better in two to six weeks. You may need to be treated in the hospital if you have a fever higher than 100.4°F, a high white blood cell count, or a lot of fluid in the sac around your heart. You may also be at risk of getting very sick if you take blood thinner medicine, have a weak immune system, have hurt your chest before, or do not get better with NSAIDs.