Key takeaways

  • Recurrent pericarditis happens when inflammation of the pericardium (the protective sac around the heart) returns 4 or 6 weeks after the initial episode resolves.
  • The most common symptom is sharp chest pain that may worsen when lying down or breathing deeply and often eases when sitting up and leaning forward. Other symptoms may include shortness of breath, fever, fatigue, swelling, and irregular heartbeat.
  • Because recurrent pericarditis symptoms can feel like a heart attack, call 911 if you experience sharp chest pain, difficulty breathing, irregular heartbeat, or fever.

Pericarditis is when the pericardium becomes inflamed. The pericardium is a sac-like structure composed of two thin layers of tissue that surround the heart, providing protection.

If a person goes 4 or 6 weeks without symptoms after their initial episode, but then experiences symptoms again, this is known as a flare. At that point, a healthcare professional may diagnose recurrent pericarditis.

The signs of recurrent pericarditis can be similar to a heart attack, so it’s important to know how to recognize them and know when to get medical attention.

The most common symptom of pericarditis is chest pain, which is present in almost all cases.

The chest pain could feel like a stabbing sensation, a dull ache, or pressure. The pain may also spread to the neck, shoulder, arm, upper back, or abdomen.

This type of pain may also become worse when lying down, coughing, or taking deep breaths.

Partially leaning forward and sitting up straight may ease the pain.

There are other symptoms to be aware of, which may help you identify a recurrent pericarditis flare.

Chest pain and discomfort

Chest pain is the main symptom of pericarditis. However, this can also indicate a heart attack or other health conditions that should be ruled out, so it is vital to call 911 to ensure prompt medical care.

Other reasons for chest pain include:

  • conditions that affect the blood supply to the heart
  • conditions that affect oxygen supply to the heart
  • a tear to the inner layer of the aorta, which is the body’s main artery, known as aortic dissection
  • inflammation of the heart muscle (myocarditis)
  • inflammation of the lung lining (pleurisy) secondary to blockage in one of the lung’s arteries (pulmonary embolism) or pneumonia
  • costochondritis, which affects the rib cartilage
  • esophageal spasm
  • peptic ulcer disease
  • referred pain from another organ, for example, acute inflammation of the gallbladder (cholecystitis)

Shortness of breath

The inflammation, swelling, and irritation of the pericardium can cause a person to feel short of breath.

This may occur when being physically active, but may also occur when lying down.

Shortness of breath may occur due to a swollen pericardium, which restricts the heart’s ability to pump effectively and can lead to fluid buildup.

Fever and flu-like symptoms

Pericarditis can cause flu-like symptoms because the inflammation may be triggered by a viral or respiratory infection or the body’s autoimmune response.

Symptoms may include:

  • cough or other upper respiratory symptoms
  • fatigue
  • muscle aches
  • high body temperature (fever)

Fatigue and weakness

When the body fights infection, it can take a physical toll, leading to fatigue, tiredness, and weakness.

These symptoms occur because the irregular pericardium interferes with the heart’s pumping, preventing it from pumping enough blood for the body to function optimally.

Swelling

Swelling, also known as edema, occurs in pericarditis due to an inflamed, irritated pericardium, leading to fluid accumulation.

Because fluid buildup impairs the heart’s ability to pump effectively, blood backs up in the veins, leading to swelling in the legs, abdomen, and sometimes the lungs.

Heart palpitations or irregular heartbeat

The swelling can also cause an irregular heartbeat.

This can be heart palpitations, which feel like a “fluttering” sensation, or a faster-than-usual heartbeat.

Symptoms of recurrent pericarditis may change with each flare.

The initial episode is typically the most severe. Subsequent flares may be milder and sometimes harder to diagnose and manage. The duration between episodes can also vary significantly from person to person.

There are occasions when diagnostic tools will reveal signs of pericarditis.

  • Blood tests: A doctor may recommend these tests to establish:
    • whether a person may have had a heart attack
    • whether there is — or how much inflammation is — in the pericardium
    • the cause of pericarditis
  • Electrocardiogram (EKG): This test measures the electrical activity of the heart. Specific findings may indicate pericarditis.
  • Chest X-ray: This test takes pictures of the heart, lungs, and blood vessels. It can indicate whether the heart is enlarged due to fluid buildup in the pericardium. X-rays can also reveal signs of infection and other conditions that may point toward pericarditis.
  • Echocardiogram (ECG/Echo): This test uses sound waves to picture the heart. It can show the heart’s size and shape, indicate how well it is functioning, and detect a fluid buildup in the pericardium.
  • Computed tomography (CT) scan: Doctors may use a cardiac CT scan to obtain a clear, detailed picture of the heart and pericardium. It is not a primary diagnostic tool for pericarditis, but emergency room doctors may use it to help rule out other causes of chest pain.
  • Magnetic resonance imaging (MRI): Cardiac magnetic resonance (CMR) imaging uses radio waves and magnets to produce images of the heart, including changes in the pericardium.

Pericarditis symptoms can feel like a heart attack or another serious health condition. If a person experiences the following, they should call 911 — or their local emergency number — and get immediate medical attention:

  • sharp chest pain that worsens with breathing and may ease when sitting up and leaning forward
  • irregular, fast heartbeat, which may be a pericardial friction rub
  • difficulty breathing or feeling short of breath
  • mild or severe neck or shoulder pain
  • high body temperature or fever

Signs of pericarditis can look a lot like a heart attack, so it’s important that a person gets urgent medical care if they feel chest pain or worsening symptoms.

Chest pain is the most common symptom of pericarditis, but other signs and symptoms include fatigue, fever, and flu-like symptoms.

After the initial episode, returning symptoms, known as flares, are typically milder, but individuals should still get medical care as soon as possible.