Symptoms and Diagnosis of Pericarditis

What are signs and symptoms of pericarditis?

A common symptom of acute pericarditis is chest pain. The pain can start suddenly. It is often felt in the middle or left side of the chest and may spread to one or both shoulders. The pain is usually worse when lying on your back and often feels better when you sit up and lean forward.

If you have chest pain, call 911 right away. You may be having a heart attack.

Other symptoms of acute pericarditis include:

• Low-grade intermittent fever
• Weakness
• Trouble breathing
• Coughing
• Difficulty swallowing

You may also have palpitations. These can feel like your heart is skipping a beat, fluttering or beating too hard or too fast. Palpitations can have many causes and are not specific to pericarditis.

Chronic pericarditis often causes:

• Tiredness
• Coughing
• Shortness of breath

Some people with chronic pericarditis don’t have chest pain. Severe cases of chronic pericarditis can cause swelling in the stomach, feet, ankles and legs.

What are complications of pericarditis?

Two serious complications of pericarditis are cardiac tamponade and chronic constrictive pericarditis.

• Cardiac tamponade happens when too much fluid builds up around the heart. The fluid puts pressure on the heart, making it hard for the heart to fill and pump blood. This can cause a dangerous drop in blood pressure. If untreated, cardiac tamponade can be life-threatening.
• Chronic constrictive pericarditis is a rare condition that usually develops over time. Scar tissue forms around the heart, making the sac stiff and tight. This stiffness can squeeze the heart and keep it from working properly.

How is pericarditis diagnosed?

A healthcare professional diagnoses pericarditis based on your medical history, physical exam and test results.

Specialists involved

A primary care doctor — such as a family doctor, internist or pediatrician — often diagnoses and treats pericarditis. Depending on your age and health needs, a cardiologist, pediatric cardiologist or infectious disease specialist may also be involved.

Medical history

Your healthcare professional may ask whether you have had:

• A recent respiratory infection or flu-like illness
• A recent heart attack or chest injury
• Other medical conditions

If you have chest pain, you may also be asked to describe how it feels, where the pain is located and whether it gets worse when you lie down, breathe or cough.

Physical exam

When the lining around the heart (pericardium) is inflamed, the two layers can rub against each other. A healthcare professional may hear a pericardial rub using a stethoscope. This sound is more common in people with acute pericarditis than in those with chronic pericarditis.

A healthcare professional may also hear other chest sounds that are signs that fluid has built up around the heart (pericardial effusion) or in the lungs (pleural effusion). These conditions are more severe problems related to pericarditis.

Diagnostic tests

Here are the most common tests used to diagnose pericarditis and how severe it is:

• Blood tests: Check for signs of inflammation (such as C-reactive protein) and help rule out other problems, such as heart attack.
• EKG (electrocardiogram): Measures your heart’s electrical activity. Certain results may point to pericarditis.
• Chest X-ray: Shows pictures of your heart, lungs and blood vessels. It can show extra fluid around your heart or other conditions that may cause pericarditis.
• Echocardiography (Echo): Uses sound waves to create pictures of your heart and show how well it’s working. It can show fluid around the heart.
• Cardiac CT (computed tomography): Uses X-rays to create detailed pictures of your heart and pericardium. It helps rule out other causes of chest pain.
• Cardiac MRI (magnetic resonance imaging): Also called CMR, this test uses magnets and radio waves to create detailed pictures. It can show changes in the pericardium.