The pericardium is a thin, sac-like covering (a membrane) that surrounds your heart. The outer layer of the pericardium surrounds the roots of your heart’s major blood vessels. Ligaments attach this layer to your spinal column, diaphragm, and other parts of your body. The inner layer of the pericardium is attached to the heart muscle. A coating of fluid separates the two layers of membrane, letting the heart move as it beats, yet still be attached to your body.

Pericarditis is inflammation of the pericardium, causing the amount of fluid between the two layers of the pericardium to increase. This increased fluid presses on the heart and restricts its pumping action.

What causes pericarditis?

Pericarditis occurs most often in men between the ages of 20 and 50 years old and can result from

• A viral, bacterial, or fungal infection
• A heart attack
• Cancer that has spread from a nearby tumor
• Radiation treatment for some types of cancer
• Injury to your chest, esophagus (food pipe), or heart
• Use of certain kinds of medicines to suppress your immune system

Pericarditis may also occur in patients who have rheumatoid arthritis, lupus, kidney failure, leukemia, HIV, or AIDS.

What are the symptoms?

The main symptom of pericarditis is a sharp, stabbing pain in the center or the left side of your chest. (In some cases, the pain may be dull.) The pain may spread to your neck or left shoulder and can worsen when you take a deep breath. The pain is usually lessened if you are sitting up or leaning forward but can worsen when you lie down.

Other symptoms may include

• Fever
• Cough
• Pain when swallowing
• Trouble breathing
• An overall feeling of sickness

How is pericarditis diagnosed?

Most doctors will suspect pericarditis if you tell them your symptoms and the history of your pain.

• With a stethoscope, a doctor can listen for “rubbing” sounds in your chest, which indicate that there is fluid around your heart. If the condition is severe, doctors may hear “crackles” in your lungs, which is a sign of fluid in the space around the lungs.
• A chest x-ray will show if your heart is enlarged because of increased fluid in the pericardium.
• Electrocardiography (an ECG or EKG) can help doctors learn more about your heart rhythm and the size and function of the chambers of your heart.
• Echocardiography can be used to see heart wall motion and overall heart size. This is also one of the better tests for showing fluid buildup around the heart.
• A sample of the fluid from the pericardium can be removed using a needle. This procedure is called pericardiocentesis. The fluid sample can then be tested for signs of infection.

Other imaging techniques may be used for a more complete diagnosis.

How is pericarditis treated?

Pericarditis is treated with pain relievers and anti-inflammatory medicines. If pericarditis is caused by an infection, antibiotic medicines are prescribed.

If the increased fluid in the pericardium restricts the pumping action of your heart, pericardiocentesis may be needed to remove the extra fluid.

In rare cases, surgery may be needed.

If you have had acute pericarditis, meaning the infection has happened recently, you will usually recover within 1 to 3 weeks. Chronic pericarditis may last for several months.