Recurrent Pericarditis

What is recurrent pericarditis?

Recurrent pericarditis is when you develop pericarditis for a second time after having no symptoms for at least four weeks. This return of inflammation is also known as a “flare.”

Pericarditis is inflammation of the pericardium, a sac-like organ with two thin layers of tissue that surround the heart. The pericardium holds the heart in place, protects it from infection, and keeps it from filling with too much blood. It also cushions the heart from outside pressure. A small amount of fluid keeps the layers separate and decreases the friction between them as the heart beats. But in some people with this condition, these tissues become swollen and irritated. This can cause sharp chest pain and may lead to fluid buildup around the heart that causes discomfort. In most cases, pericarditis is mild and gets better on its own without treatment.

Among those treated for acute pericarditis, 15% to 30%, or nearly 40,000 people in the United States, may experience recurrent pericarditis if not treated with the medication colchicine. About 5% of people seeking treatment in emergency departments for chest pain had acute pericarditis.

Other types of pericarditis include:

• Acute pericarditis lasts less than four to six weeks.
• Incessant pericarditis symptoms last more than four to six weeks but less than three months despite therapy.
• Chronic pericarditis lasts for more than three months. 

View the Recurrent Pericarditis Fact Sheet (PDF)

What are the symptoms of recurrent pericarditis?

Symptoms of pericarditis can be the same regardless of how many times you’ve had it, but most people experience some combination of these common symptoms:

• Chest pain is almost always present. It may feel like a sharp, stabbing pain that radiates to the arm, neck, shoulder, back or abdomen. Some people mistake the pain for a heart attack. The pain gets worse when coughing, taking deep breaths or lying down. The pain may improve by sitting up and leaning forward.
• Back, neck or shoulder pain radiating from the chest pain
• Shortness of breath or difficulty breathing
• Heart palpitations or a faster than normal heartbeat
• Low-grade fever, chills or sweating
• Dry cough
• Swollen abdomen, legs or feet
• Low blood pressure symptoms, such as lightheadedness, dizziness or fainting
• Weakness or fatigue

Be sure to tell your doctor if you’ve had any of these symptoms. Note that many people with pericarditis report being misdiagnosed with acid reflux or heartburn. Women, in particular, report being wrongly diagnosed with panic attacks, stress or anxiety.

View the Recurrent Pericarditis Symptoms Sheet (PDF)

What causes recurrent pericarditis?

The cause of pericarditis is idiopathic, or unknown, in most patients, but potential causes of a first-time episode of pericarditis include:

Viral illnesses, such as herpes, influenza, adenovirus, enterovirus or Epstein Barr virus may also cause recurrent pericarditis.

Other potential causes include:

• Autoimmune conditions such as lupus, scleroderma and rheumatoid arthritis
• Complications from a heart attack or heart surgery
• Health problems, such as kidney failure or cancer
• Bacterial, fungal and parasitic infections (most common in people with compromised immune systems)
• Radiation to the chest
• Chest trauma
• Certain medications, such as phenytoin (an anti-seizure medicine) and procainamide (prescribed for irregular heartbeats)

If a pericarditis flare happens again, it’s often because the initial episode (or flare) wasn’t fully resolved or because the body has had an autoinflammatory response.

View the Causes of Recurrent Pericarditis Sheet (PDF)

How is recurrent pericarditis diagnosed?

Depending on your age and medical conditions, a primary care doctor, cardiologist, rheumatologist or infectious disease specialist may treat you.

If your doctor believes you may have pericarditis, they’ll listen to your heart for rubbing sounds that often occur in people with the condition. One or more of the following tests may be used to confirm the diagnosis:

• Blood test: May reveal elevations in the white blood cell count and other signs of inflammation.
• EKG (electrocardiogram): Measures your heart’s electrical activity and certain results may suggest pericarditis.
• Chest X-ray: Takes pictures of the heart, lungs and blood vessels inside your chest. An X-ray can show whether the heart is enlarged due to excess fluid in the pericardium. It may also reveal signs of infection, sarcoidosis or malignancies that may cause pericarditis.
• Echocardiogram: Sound waves create pictures of your heart’s size, shape and how it’s working. This can reveal fluid buildup in the pericardium.
• Cardiac CT (computed tomography): A type of X-ray that takes a clear, detailed picture of your heart. It can help identify inflammation, thickening, or calcification of the pericardium, as well as fluid buildup.
• Cardiac MRI (magnetic resonance imaging): Also called CMR, this test uses magnets and radio waves to create detailed images of your heart and surrounding tissues. This can reveal changes in the pericardium.

Let your doctor know if you’ve been diagnosed with pericarditis or had symptoms before and if you’ve recently been sick with any viral infection, such as the flu, herpes or a stomach virus. Also share if you have any autoimmune conditions, such as lupus, scleroderma or rheumatoid arthritis.

Recurrent pericarditis can be difficult to diagnose because it is relatively rare, and patients can go months in between episodes. In patients receiving NSAID therapy – whether as ongoing treatment for a previous episode of pericarditis or for another condition (e.g., arthritis) – symptoms of a recurrent flare may be partially masked. Even if you have been diagnosed in a hospital emergency room or urgent care center, be sure to tell your primary care doctor or health care professional about every occurrence. They can make sure you get treated for possible recurrent pericarditis.

View the Recurrent Pericarditis Diagnosis Sheet (PDF)

How is recurrent pericarditis treated?

Managing this condition focuses on reducing inflammation, preventing future recurrences, and minimizing complications. Treatment typically involves a combination of medications and lifestyle modifications tailored to each patient’s needs.

Recurrent pericarditis is usually treated with the anti-inflammatory drug colchicine and aspirin and non-steroidal anti-inflammatory drugs (NSAIDS). You may also be advised to limit or restrict physical activity to help your body respond to the medication and prevent the pericarditis from returning.

When NSAIDs and colchicine don’t lead to a complete resolution, low to moderate doses of corticosteroids, such as prednisone may also be prescribed. Because steroids have been linked with a higher risk of recurrence, they’re typically used in people who can’t tolerate NSAIDs or colchicine or in those who are pregnant or have conditions such as autoimmune disease. Interleukin 1 blockers, which neutralize pro-inflammatory molecules, may also be prescribed for patients who don’t respond to medications to achieve better symptom control.

Your doctor may perform a pericardiocentesis where excess fluid is drained from the pericardium. Or as a last result, the pericardium may be removed partially or entirely. This is called a pericardiectomy.

Ask your health care professional how long you can expect to be on any medication and any potential side effects you might experience. If you need financial help, your pharmacist can tell you about possible coupons or prescription assistance programs.

View the Recurrent Pericarditis Treatment Sheet (PDF)

Get Support

It’s normal to feel scared, overwhelmed or confused after being diagnosed with recurrent pericarditis. Getting support from people experiencing the same journey can help you cope. Our online community of patients, survivors and caregivers is here so you and your loved ones can share your experiences, get support from others and ask questions Find encouragement and join our Support Network.

Outlook

For most people, recurrent pericarditis can be safely managed at home and rarely leads to death. But it can cause potentially life-threatening complications, such as loss of the pericardium’s elasticity (constrictive pericarditis) and a buildup of fluid in the pericardium (cardiac tamponade). Some people with pericarditis may also have pericardial thickening.

Seek medical treatment if you have continued symptoms of pericarditis.

If you feel chest pain of any type, immediately call 911 because it may be a sign of a heart attack. If you have recurrent pericarditis, be sure to talk to your doctor about your symptoms and treatment options.

View the Discussion Guide: Before and After Diagnosis (PDF)

Remember to speak up for yourself. Because pericarditis is relatively rare, your health care professional might not be familiar with the symptoms or treatment options. Don’t hesitate to get a second opinion or to consult a specialist. Many health care professionals support and encourage patients to get second, and even third, opinions to ensure the best care.