Pericarditis is an inflammatory disease of the pericardium, a fibrous sac surrounding the heart. The main symptom of pericarditis is sharp stabbing chest pain, usually worse on breathing in and lying down. Pericarditis is a relatively common cardiac disease. 5% of all patients presenting to A&E with chest pain have pericarditis. Pericarditis is more common in men than women and adults and the elderly than in children.

The pericardium

The pericardium is a double-layered fibrous sac around the heart. A small amount of viscous fluid separates the layers of the pericardium. Pericardium works as a shock absorber that protects the heart from injury and variation in blood pressure. The pericardial fluid acts as a lubricant to minimize friction during cardiac contraction and relaxation. Due to its role in protecting the heart, even a mild inflammation can cause considerable chest discomfort mimicking a heart attack.

Types of pericarditis
Acute pericarditis

Symptoms last less than three months and usually improve within a week or so. Most cases of acute pericarditis are assumed to be due to a viral infection, but in 90% of patients, the exact cause is not found, and these cases are then called idiopathic pericarditis.

Recurrent pericarditis

Approximately 25% of people with acute pericarditis develop recurrent pericarditis. No clear reason has been identified, but perhaps the previous infection triggers an immune reaction, leading to the recurrence of pericardial inflammation.

Chronic pericarditis

Chronic pericarditis lasts more than 3 months and is more likely to be caused by a bacterial infection such as tuberculosis. Chronic pericarditis may result in a pericardial constriction, leading to heart failure and requiring surgical intervention.


Non-steroidal anti-inflammatory (NSAIDs) drugs are the treatment of choice for acute pericarditis. In some patients, a significant amount of fluid accumulates in the pericardial space and interferes with the heart’s pumping function. This complication of pericarditis is called tamponade, is diagnosed by echocardiography and requires urgent drainage to remove the fluid (pericardiocentesis). Colchicine is used for recurring pericarditis because it reduces the risk of relapse. The treatment of chronic pericarditis depends on the underlying problem; usually, medical treatment is sufficient but, in some cases, a surgical intervention (pericardiectomy, surgical removal of part or most pericardium).

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