Pericarditis

The most common sign is sharp chest pain. This pain is often intense and throbbing, sometimes described as sudden. It is usually located in the center or on the left side of the chest and can spread to the left shoulder or neck.

Unlike a heart attack, this pain intensifies when you breathe deeply, cough, or lie down, and it subsides when you sit up and lean forward slightly. This is a fairly typical sign of pericarditis.
Other symptoms may also appear:

• A feeling of shortness of breath, especially when lying down.
• General fatigue or a feeling of weakness.
• Palpitations, i.e., irregular or rapid heartbeat.
• Mild fever or body aches, especially if the pericarditis is related to an infection.

In older people, chest pain is sometimes less pronounced. In this case, breathing difficulties or fatigue may be more prominent (dyspnea).

In many cases, the exact cause of pericarditis remains unknown. This is referred to as “idiopathic” pericarditis. However, it is very often associated with a clinically unidentified viral infection.

The most common causes are:

• Viral infections: these are the most common. Viruses such as influenza, herpes, HIV, or hepatitis may be responsible.
• Bacterial infections, such as tuberculosis: these are rarer but can be more serious.
• Autoimmune diseases: in these cases, the body's defense system mistakenly attacks its own tissues, including the pericardium. This is the case in diseases such as lupus or rheumatoid arthritis.
• Complications after heart surgery or a heart attack: this is known as post-operative or post-infarction syndrome.
• Cancers: certain types, such as lung or breast cancer, can affect the pericardium.
• Trauma: a blow to the chest, such as after a car accident, can trigger pericarditis.
• Chronic health problems, including kidney failure or hypothyroidism (underactive thyroid).
• Certain medications: in rare cases, treatments can cause inflammation of the pericardium (particularly those used to treat epileptic seizures or heart rhythm disorders).

Pericarditis can affect anyone, regardless of age. However, certain profiles seem to be more at risk. Men between the ages of 16 and 65 are most commonly affected.
Certain factors increase the risk of developing pericarditis, including:

• A recent infection, especially a viral infection (such as a cold or flu).
• Having an autoimmune disease, such as lupus or rheumatoid arthritis.
• Recent heart surgery or a heart attack.
• A chronic disease such as kidney failure.
• Treatment with certain medications, particularly those used to treat heart rhythm disorders or epilepsy.

People who are immunocompromised, particularly those living with HIV or who have undergone chemotherapy, are also at greater risk because their immune systems are weakened.

The diagnosis of pericarditis is based on several simple and accessible steps. During a consultation, the healthcare professional begins by listening to the symptoms. Typical chest pain is a strong initial indicator, especially if it varies depending on body position and is accompanied by fever.

Several tests may then be recommended:

• An electrocardiogram (ECG) reveals disturbances in the heart's electrical activity, particularly those typical of pericarditis.
• A chest X-ray: this can show an enlargement of the heart's shadow if excess fluid has accumulated in the pericardium.
• Cardiac ultrasound: this painless test uses ultrasound to visualize the pericardium and detect any fluid around the heart.
• Blood tests are also useful for detecting inflammation (measurement of CRP or sedimentation rate) or infection.

In certain specific cases, other tests may be necessary to identify a specific cause, such as tuberculosis or cancer.

Most cases of pericarditis heal well, especially when treated promptly. Treatment generally involves three main approaches:

1. Rest: This is essential for relieving pain and allowing the heart to recover.
2. Anti-inflammatory drugs: such as ibuprofen or high-dose aspirin, these are used to reduce inflammation. These treatments must be combined with a stomach protector.
3. Colchicine: a drug often prescribed as a supplement, particularly to prevent recurrence. The duration of treatment varies depending on the case, between three and six months.

In some more complex cases:

• Corticosteroids may be prescribed if anti-inflammatory drugs are ineffective or contraindicated. They must be discontinued gradually to avoid relapses.
• Drainage may be necessary if a large amount of fluid surrounds the heart, or if a complication called cardiac tamponade develops. This is a medical procedure that involves removing the fluid, sometimes under local anesthesia.

In most cases, acute pericarditis heals without significant sequelae. Pain usually subsides within a few days, and signs of inflammation in the blood disappear within two to six weeks.

However, certain complications may arise. The most common is recurrence, i.e., the return of symptoms several weeks after the initial episode. This can happen especially if the cause is viral, after heart surgery, or if treatment is stopped too quickly.

More rarely, chronic constrictive pericarditis may occur. This stiffness of the pericardium interferes with the heart's ability to expand properly during filling. Although rare, this condition can appear several months after an initial episode that seemed benign.

Another serious complication, called cardiac tamponade, can occur if too much fluid accumulates rapidly around the heart. This fluid compresses the heart and prevents it from functioning normally, which can lead to a significant drop in blood pressure and requires emergency treatment.

There is no guaranteed method for preventing all cases of pericarditis. However, certain measures can help reduce the risk, particularly for forms linked to infection:

• Wash your hands regularly to limit the spread of viruses.
• Avoid close contact with people who are ill, especially if they have the flu or a cold.
• Keep your vaccinations up to date.
• Treat chronic conditions such as kidney failure or autoimmune diseases properly.
• Inform your doctor if you are taking any medications that may cause inflammation of the pericardium.

It is recommended that you consult a doctor immediately if you experience unusual chest pain, especially if it:

• Is sharp, feels like a stab or a burn.
• Is relieved by sitting forward and worsened when lying down.
• Is accompanied by fever, shortness of breath, or palpitations.

Call emergency services if this pain suggests a heart attack, as only a medical examination can identify the precise cause.

If pericarditis is diagnosed, it is also important to contact your doctor again if the pain returns, intensifies, or if new symptoms appear.

L’Hôpital de La Tour offers comprehensive, personalized care for pericarditis, drawing on close collaboration between the cardiology, internal medicine, and medical imaging departments. As soon as symptoms appear, patients can be referred to the 24-hour emergency department, which performs an immediate assessment including an electrocardiogram, blood tests, and cardiac ultrasound.

Follow-up care is then provided in consultation with a specialized team that adapts treatments and monitors signs of progress. In the event of recurrence or complications, advanced treatment options are available, including pericardial drainage, treatment of the underlying cause, and support from specialists in systemic diseases if necessary.

The human and multidisciplinary approach of Hôpital de La Tour guarantees high-quality medical care, with the aim of achieving a full and lasting recovery for patients.

Is pericarditis a medical emergency?
Not always. If the pain is moderate and vital signs are stable, treatment can be provided in a doctor's office. However, sudden pain accompanied by shortness of breath or a drop in blood pressure requires immediate emergency care.

Can pericarditis be confused with a heart attack?
Yes. Both conditions can cause chest pain. However, the pain of pericarditis changes with position and breathing, which is not the case with a heart attack. Only a medical examination can tell the difference.

How long does pericarditis last?
Acute pericarditis usually lasts from a few days to six weeks. A chronic form is considered to last longer than three months. Recovery depends on treatment, rest, and the cause.

Is it a contagious disease?
No, pericarditis itself is not contagious. However, some causes, such as the viruses responsible, can be contagious.

Can you exercise with pericarditis?
No, it is recommended to avoid intense physical activity during the active phase of the disease. Activity can be resumed gradually once the symptoms have disappeared and test results are normal.

Can pericarditis come back?
Yes, in 15 to 30% of cases, especially if the initial treatment was stopped too early or if the inflammation was not completely controlled.

What tests are necessary?
An electrocardiogram, cardiac ultrasound, blood test, and sometimes an X-ray are performed to make the diagnosis and monitor progress.