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- Pericarditis — inflammation of the two-layered membrane around the heart, which causes fluid to accumulate and makes it harder for the heart to fill with blood.
- The pain worsens with deep breathing, coughing and lying on the back, and eases in a sitting position with a forward lean.
- Causes include infections, rheumatic fever, myocardial infarction, chest injury, surgery, tumours and kidney disease.
- The diagnosis is clarified by a cardiologist using an ECG, cardiac ultrasound, chest X-ray, blood tests and MRI of the pericardium.
- Severe chest pain, breathlessness or fainting are grounds to call an ambulance immediately rather than wait for a routine appointment.
What is pericarditis
Pericarditis is inflammation of the outer lining of the heart, which is called the pericardium. It can cause chest pain and make it harder for the heart to work, but it is often treatable.
What happens in the body
The pericardium is a thin two-layered membrane that surrounds the heart and helps it move freely as it contracts. Normally there is a small amount of fluid between these layers, which reduces friction with every beat. When inflammation begins in the membrane, its layers swell and become rough, and the volume of fluid between them increases noticeably. Because of this, it is harder for the heart to relax and fill with blood, so a person feels a pressing or stabbing pain behind the breastbone. The pain often gets worse with a deep breath, coughing or lying down, and eases in a sitting position with a lean forward. If too much fluid accumulates, it begins to compress the heart and prevent it from pumping blood. When such chest pain appears, it is sensible not to wait for it to pass on its own, but to see a doctor as early as possible.
What causes it to develop
- Viral or bacterial infections: the pathogens get into the lining of the heart and trigger an inflammatory reaction in it, which is what causes the pain.
- Inflammatory diseases: in rheumatic fever and similar conditions, the immune system attacks its own tissues, including the lining of the heart.
- Complication of myocardial infarction: after damage to the heart muscle, inflammation often spreads to the membrane surrounding it and intensifies the discomfort.
- Chest injury or heart surgery: a bruise, a fractured rib or a surgical procedure irritates the membrane and provokes its inflammation.
- Tumours or kidney disease: these conditions change the composition of the body's internal environment, and the lining of the heart responds to this with inflammation.
- Unclear cause: in some cases neither an infection nor another disease can be identified, and then the cause is considered undetermined.
Who encounters this more often
Pericarditis occurs in people of different ages, but it is more often detected in middle-aged men and in those who have recently had an infection or heart surgery. In children and adolescents, inflammation of the membrane often follows a viral infection of the respiratory tract. In older people, there is a higher likelihood that the membrane becomes involved in the process after a heart attack or against the background of kidney disease. A separate group consists of patients with rheumatic diseases, in whom immune inflammation affects several organs at once. Lifestyle also plays a role: smoking, alcohol abuse and neglected chronic diseases increase the heart's vulnerability to such reactions. It has also been noted that in some people the condition recurs, so an episode that has occurred should be kept under a doctor's supervision. If a person knows about their chronic disease, it is sensible to tell the doctor about it with any chest pain.
What symptoms can occur?
Pericarditis manifests in different ways: in some people the symptoms increase gradually, in others they appear suddenly. It is important to recognise the warning signs in time and understand when urgent medical help is needed.
How it is noticed at the very beginning
At the beginning, pericarditis is often felt as discomfort in the chest, which is easily put down to fatigue or a cold. Chest pain often worsens with a deep breath, coughing or lying on the back. A person may feel pressure or heaviness behind the breastbone, as if something is preventing them from breathing with a full chest. Sometimes shortness of breath appears, especially when having to lie down, and then one has to raise the head higher. The heartbeat becomes rapid, weakness and malaise appear, similar to the onset of a viral infection. Body temperature may rise, and usual tasks become harder than usual. If such sensations last longer than a couple of days or worsen, it is worth seeing a cardiologist without waiting until things become really bad.
Signs that occur most often
- Chest pain: worsens with a deep breath, coughing or lying on the back, so a person involuntarily seeks a position where the pain is weaker.
- Pressure or heaviness in the chest: felt as pressure behind the breastbone, which makes breathing seem incomplete and causes anxiety.
- Shortness of breath: especially noticeable when lying down, when one has to sit up or put pillows higher to breathe more freely.
- Rapid heartbeat: the heart beats faster than usual even at rest, and this is felt as palpitations or throbbing in the chest.
- Rise in body temperature: often accompanies inflammation and is combined with chills, aching and general malaise.
- Weakness and malaise: usual tasks become harder, fatigue sets in quickly, which was not there before with normal exertion.
When to seek help urgently
Examinations and tests
Examination for pericarditis is based on the doctor's history-taking and physical examination, while instrumental and laboratory methods clarify the picture. Below is a breakdown of what exactly is prescribed and what information each investigation provides.
How the examination begins
The examination begins with a history of symptoms and a physical examination, which give the doctor initial guidance. During the appointment, they clarify when the complaints appeared, how they changed and what makes them worse. The examination allows noticing signs that the person themselves usually does not notice or does not associate with the heart. Based on these data, the doctor decides which instrumental and laboratory investigations are needed in a particular case. Electrocardiography shows changes in the heart's function and helps assess its electrical activity. Echocardiography detects fluid around the heart, while chest X-ray assesses its size. Blood tests help find signs of inflammation, and magnetic resonance imaging clarifies the condition of the pericardium. If you come with already collected results of previous investigations, the doctor will see the dynamics faster and more accurately determine which methods are needed next.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries: take all medical documents describing previous visits and doctors' conclusions, so as not to repeat what has already been done.
- ECG results: bring previous tracings and reports, if you have them, so the doctor can compare them with the new data.
- Heart ultrasound conclusions: keep echocardiography reports with dates, because the dynamics of fluid around the heart can only be seen by comparison.
- Blood tests: collect the results of laboratory investigations, as they are used to assess signs of inflammation and how they change over time.
- Notes on how you feel: note when the complaints appeared and how they changed, this will help the doctor build a sequence of events.
- List of questions: formulate in advance what you want to clarify with the doctor, so the appointment will be more organised and unhurried.
Which doctor should I see?
If pericarditis is suspected, it is important to understand which doctor to see and how care is organised. Below — about the specialist, areas of treatment and the role of regular monitoring.
Which specialist manages this condition
Pericarditis is managed by a cardiologist — a doctor who deals with diseases of the heart and the pericardium. At the first appointment, the cardiologist asks about the nature of the pain and its connection with breathing and body position. The doctor clarifies how long ago the complaints appeared and what preceded them, in order to understand the likely cause of the inflammation. Then he examines the patient, listens to the heart and assesses whether there are signs of fluid accumulation in the pericardial cavity. If necessary, the cardiologist refers the patient for additional tests to confirm the diagnosis and assess the severity of the condition. If there is no specialist cardiologist nearby, start with a general practitioner: he will examine you and refer you to the right specialist. Do not put off the visit if chest pain worsens on inhalation or in a lying position.
What treatment consists of
- Selection of therapy by the doctor: the cardiologist determines the direction of care taking into account the cause and severity of the inflammation, in order to reduce it and relieve the pain.
- Bed rest in the acute period: limiting exertion in the first days reduces the workload on the heart and helps the body cope with the inflammation.
- Monitoring and control of the condition: regular examinations allow deterioration to be noticed in time and care to be adjusted if the patient's wellbeing changes.
- Surgery when indicated: if fluid accumulates in the pericardial cavity, the doctor may recommend its removal to relieve the heart.
- Prevention of complications: monitoring the course of the disease is needed to prevent compression of the heart and other consequences of inflammation.
What depends on the patient himself
The result largely depends on how regularly the person is monitored by a cardiologist and follows his recommendations. Pericarditis can run a fluctuating course, so even when wellbeing improves it is important to attend the scheduled examinations. The patient should tell the doctor about any new sensations: worsening pain, breathlessness, oedema or a rise in temperature. Adhering to bed rest in the acute period noticeably reduces the workload on the heart and helps recovery. If the doctor has prescribed follow-up tests, they must be done on time, and not postponed until severe symptoms appear. Records of appointment dates and wellbeing help the cardiologist assess the course of the disease more accurately. If the condition worsens, do not wait for the scheduled visit, but seek help earlier.
What helps prevent an exacerbation?
Prevention of pericarditis largely relies on a person's own everyday decisions. Below are the habits, measurements and regular monitoring that reduce the risk of an exacerbation.
What to change in your habits
Timely treatment of infections directly reduces the likelihood of recurrent inflammation of the membranes of the heart. A cold, tonsillitis or toothache endured on your feet puts a strain on the body and the heart. Managing chronic diseases requires constant attention to how you feel and to your doctor's prescriptions. Giving up smoking reduces oxygen deprivation of tissues and makes the heart's work easier. Moderate physical activity without overexertion maintains tone and circulation. Adequate sleep and rest help the body recover after exertion and stress. If shortness of breath, chest pain or swelling appear, it is important not to postpone a visit to a specialist.
What should be kept under control
- Blood pressure: it is measured regularly, because a persistent rise creates additional strain on the heart and blood vessels.
- Pulse and rhythm: changes in rate or irregularities should be recorded so that the doctor can assess them at an appointment.
- Body temperature: a prolonged rise without an obvious cause requires attention and examination by a specialist.
- Weight and swelling: rapid weight gain and puffiness of the legs may indicate fluid retention.
- Infections you have had: each one should be reported to the cardiologist, since they affect the course of the condition.
- A diary of how you feel: brief notes about pain, shortness of breath and fatigue help the doctor see the whole picture.
How often to see a doctor
Regular check-ups with a cardiologist are needed even when you feel well and have no complaints. Pericarditis can run almost unnoticed, while changes accumulate gradually and give no sign of themselves for a long time. If there are risk factors, the doctor schedules check-ups more often in order to notice trouble in time. Chronic diseases of the heart and blood vessels require constant monitoring and adjustment of lifestyle. Infections you have had also become a reason to see a specialist outside the schedule. At an appointment it is important to tell about all changes in how you feel, even those that seem insignificant. Such monitoring helps to notice an exacerbation in time and not let the condition progress to a severe form.
What is worth remembering
Pericarditis rarely occurs as an isolated disease: more often it turns out to be the body's reaction to another process, so it is more important not to memorise a set of signs, but to understand the logic of actions. Below is what stays with the reader after becoming familiar with the topic.
Main conclusions
Pericarditis requires attention to one's own condition, because its course can vary: from subtle manifestations to rapid deterioration in well-being. Pericarditis does not always produce a clear picture, and a person attributes discomfort in the chest to fatigue or a cold. Pericarditis is dangerous not so much in itself as through the possibility of fluid accumulating around the heart. Pericarditis makes one take into account that the pain intensifies on deep inspiration and in the lying position. Pericarditis often returns if the cause that triggered it has remained unaddressed. Pericarditis is identified by the combination of complaints, examination and test results, rather than by a single sign. Pericarditis is a reason not to wait and not to select treatment for oneself, but to discuss the condition with a doctor as early as possible.
