Pericarditis Treatment: Causes, Symptoms and Treatment

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Pericarditis Treatment: Causes, Symptoms and Treatment

  • Category

    Cardiology

  • Published By

    GetWellGo Team

  • Updated on

    12-Jun-2025

Pericarditis treatment

Pericarditis refers to inflammation of the pericardium, a thin sac-like membrane enveloping the heart. It is treated according to the cause, degree, and nature (acute, recurrent, chronic, or constrictive) of pericarditis.

Causes of pericarditis

Pericarditis happens when the pericardium (the two-layered membrane that encases the heart) is inflamed. Causes are infectious, non-infectious, and autoimmune.

Infectious Causes

  • Viral (most frequent): Coxsackievirus, Echovirus, Influenza, HIV, Hepatitis B/C, COVID-19
  • Bacterial: Tuberculosis (TB), Staphylococcus, Streptococcus
  • Fungal: Histoplasmosis, Candida (rare)
  • Parasitic: Toxoplasmosis, Echinococcosis (rare)

Autoimmune / Inflammatory Diseases

  • Systemic lupus erythematosus (SLE)
  • Rheumatoid arthritis
  • Scleroderma
  • Sarcoidosis
  • Ankylosing spondylitis
  • Mixed connective tissue disease

Post-Heart Injury Causes (Post-Cardiac Injury Syndrome)

  • Post-myocardial infarction (Dressler's syndrome): Immune reaction after heart attack
  • Post-pericardiotomy syndrome: Following heart surgery
  • Chest trauma: Penetrating or blunt injury

Drug-Induced Pericarditis

Certain drugs may induce inflammation of the pericardium:

  • Procainamide
  • Hydralazine
  • Isoniazid
  • Phenytoin
  • Minoxidil
  • Certain chemotherapy agents (e.g., doxorubicin, cyclophosphamide)

Cancer-Related (Malignant Pericarditis)

  • Direct invasion: Breast, lung, or esophageal carcinoma
  • Hematologic: Leukemia, lymphoma
  • Metastatic disease to pericardium

Metabolic Disorders

  • Uremia (renal failure)
  • Hypothyroidism

Other Causes

  • Radiation therapy to the chest
  • Aortic dissection
  • Idiopathic (cause not known – most prevalent in developed nations)

Pericarditis symptoms

Symptoms of pericarditis vary with the type, etiology, and severity. The most frequent is acute pericarditis, and its classic symptom is chest pain.

Symptoms:

Chest pain

  • Sharp, stabbing, or dull discomfort usually in the middle or left side of the chest. Frequently worsens when lying down and eases with sitting or leaning forward.

Fever

  • Low- to medium-grade fever, particularly for infectious or autoimmune etiology.

Shortness of breath

  • Especially when lying down or because of pericardial effusion.

Palpitations

  • Sensation of rapid or irregular heart rate.

Fatigue/Weakness

  • As a result of systemic inflammation or impaired cardiac function.

Dry cough

  • Occasionally observed in viral or uremic pericarditis.

How to treat pericarditis?

Treatment of pericarditis is based on the etiology, severity, and underlying cause. The majority of cases are self-limited and viral or idiopathic, thus being mild.

First-Line Therapy for Acute Pericarditis

Objective: Mitigate inflammation, alleviate pain, and prevent recurrence

NSAIDs (ibuprofen, aspirin, indomethacin)

  • Decrease inflammation & chest pain
  • Used for 1–2 weeks; taper along with the improvement of symptoms

Colchicine

  • Prevent recurrence
  • Administered for 3 months (acute) to 6 months (recurrent)

Proton Pump Inhibitors (PPIs)    

  • Protect stomach lining    
  • Used with NSAIDs to minimize gastric side effects

If NSAIDs/Colchicine Fail or Are Contraindicated

  • Corticosteroids (e.g., Prednisone): Autoimmune pericarditis, intolerance to NSAIDs, or cases of severe/refractory nature
  • Immunosuppressants (e.g., azathioprine, methotrexate): Recurrent steroid-dependent or autoimmune cases
  • Anakinra (IL-1 blocker): Resistant recurrent or chronic pericarditis

Recurrent Pericarditis Treatment

  • Maintain colchicine + low-dose NSAIDs
  • Avoid early steroid use unless required
  • Anakinra or intravenous immunoglobulin (IVIG) should be considered in challenging autoimmune cases

Treating Specific Causes

  • Viral: NSAIDs + Colchicine
  • Tuberculosis (TB): Anti-TB drugs for 6–12 months
  • Bacterial (non-TB): IV antibiotics + potential pericardial drainage
  • Uremic pericarditis: Dialysis (no NSAIDs)
  • Autoimmune: Steroids + immunosuppressants    
  • Post-MI (Dressler's syndrome): Aspirin + colchicine

Pericardial Effusion / Cardiac Tamponade

  • Pericardiocentesis: Drain excess fluid from pericardial sac
  • Pericardial window surgery for recurrent or large effusions
  • Hospitalization if tamponade or suspected bacterial cause

Constrictive Pericarditis

  • Diuretics to decrease fluid overload
  • Surgical pericardiectomy (removal of pericardium) if severe or persistent symptoms

Supportive Care

  • Rest until symptoms and inflammation markers (such as CRP) return to normal
  • Steer clear from exercise in acute inflammation
  • Follow-up with echocardiography and ECG observations

Pericarditis chest pain relief

Pericarditis chest pain is typically sharp, aggravated by deep breathing or lying down, and relieved by leaning forward or sitting up. Management and relief are as follows:

Pain Relief Medications

  • NSAIDs (e.g., Ibuprofen, Aspirin, Indomethacin): Initial treatment to decrease inflammation and pain
  • Colchicine: Prevent recurrence and decrease inflammation
  • Acetaminophen (Paracetamol): Mild pain if NSAIDs are not tolerated
  • Corticosteroids (e.g., Prednisone): For NSAID-resistant or autoimmune pericarditis.

Key Supportive Measures

  • Rest: Reduce physical activity until pain and CRP/inflammation markers return to normal.
  • Positioning: Sit and lean forward to relieve pressure on the heart.
  • Avoid flat lying: Pain usually worsens when lying flat.
  • Hydration: Maintain hydration unless fluid restriction is appropriate (e.g., in effusion or kidney problems).

When to Seek Urgent Help

Get medical attention immediately if:

  • Pain becomes suddenly worse or crushing
  • You become faint or short of breath
  • You have low blood pressure, muffled heart sounds, or distended neck veins (indications of cardiac tamponade)

Long-Term Prevention of Recurrence

  • Finish entire course of colchicine
  • Don't discontinue NSAIDs prematurely
  • Avoid heavy exertion during and immediately after the acute phase

Best hospital for pericarditis in India

Pericarditis in young adults

Pericarditis — inflammation of the pericardium (the heart sac) — may occur in young adults, particularly males between the ages of 20–40. Although usually self-limiting, it may be recurrent or severe if not correctly treated.

Prevalent Causes Among Young Adults:

  • Viral infections (most common)
  • Post-viral immune response
  • Autoimmune diseases    
  • Chest trauma
  • Post-cardiac injury syndrome
  • Certain medications
  • Pericarditis after COVID-19 vaccine (rare)

Pericarditis diagnosis and management

Diagnostic Criteria (≥2 of 4 required):

  • Chest pain — pleuritic, sharp, relieved by sitting and leaning forward
  • Pericardial friction rub — scratchy, high-pitched sound on auscultation
  • ECG changes — diffuse ST elevation and PR depression (early), normalization (intermediate), T-wave inversion (late)
  • Pericardial effusion — detected on echocardiogram

Supporting Investigations:

  • ECG: Diffuse ST elevations, PR segment depression (especially in I, II, aVL, V2–6)
  • Echocardiogram: To exclude effusion or tamponade
  • Chest X-ray: Usually normal unless there is large effusion
  • Cardiac enzymes: Mild elevation of troponin if there is myocarditis involved
  • Inflammatory markers: ↑ ESR, ↑ CRP
  • CBC: Leukocytosis may be present
  • Viral serologies, autoimmune screen, TB testing, HIV, or uremic panel — if a specific etiology is suspected

ECG findings in pericarditis

Pericarditis classically causes diffuse, non-ischemic electrocardiographic (ECG) changes that progress in four stages. These are recognized and help to differentiate pericarditis from myocardial infarction and other cardiomyopathies.

Stage-wise Changes in ECG:

Stage I (Hours to Days):

  • Widespread (diffuse) concave ST-segment elevation
  • Is observed in all leads except aVR & V1
  • Most evident in I, II, III, aVL, aVF, V3–V6
  • PR-segment depression
  • Particularly in limb leads and precordial leads
  • PR elevation in aVR is a useful reciprocal change

Stage II (Days to a Week):

  • ST segments become baseline
  • PR depression disappears
  • T waves flatten

Stage III (1–3 weeks):

  • T-wave inversion (following normalization of ST)
  • No Q waves (in contrast to MI)

Stage IV (Weeks to Months):

  • ECG returns to baseline or persists with constant T-wave inversion

Difference between acute and chronic pericarditis

Acute Pericarditis

  • Acute pericarditis is defined as inflammation of the pericardium of duration less than six weeks. 
  • It usually presents with sudden onset and emergent symptoms. 
  • The most frequent cause of acute pericarditis is viral infection, but it may also be caused by bacterial infection, autoimmune conditions, myocardial infarction (post-MI), uremia, or trauma. 
  • Acute pericarditis classically presents with sudden, pleuritic chest pain, which aggravates on recumbency and becomes less severe when sitting up and leaning forward. 
  • Fever and pericardial friction rub on auscultation also occur. 
  • ECG changes in acute pericarditis are characteristically typical and progress through phases. These are diffuse ST-segment elevation and PR-segment depression during the initial stages. 
  • Echocardiography in acute pericarditis can reveal a small pericardial effusion but typically no structural abnormality. 
  • Treatment of acute pericarditis typically involves anti-inflammatory drugs like NSAIDs and colchicine. Corticosteroids can be employed in the case of refractory or autoimmune pericarditis.

Chronic Pericarditis

  • Chronic pericarditis lasts for over three months and has a tendency to progress gradually over time. 
  • The chronic variety may ensue from an improperly treated or recurrent acute attack, or it might happen alone. 
  • Chronic pericarditis is more commonly linked with longstanding illnesses like tuberculosis, radiation treatment, autoimmune illnesses (such as lupus or rheumatoid arthritis), neoplastic illness, or recurrent pericardial inflammation resulting in fibrosis and pericardial thickening. 
  • Chronic pericarditis can have fewer or milder manifestations. Chest pain can be absent, and they are more likely to be due to compromised heart function, like fatigue, dyspnea, and evidence of heart failure—particularly in constrictive pericarditis. 
  • Chronic pericarditis, nonetheless, ECG alterations are often nonspecific or even normal, as the acute inflammatory phase has normally passed. 
  • Chronic pericarditis, imaging like echocardiogram, CT, or MRI might show thickened, fibrotic, or calcified pericardium and, occasionally, an increased effusion. 
  • Constrictive physiology can occur in severe chronic cases. 
  • Treatment of chronic pericarditis includes treatment of the cause, and can consist of long-term anti-inflammatory therapy. 
  • In constrictive pericarditis, surgery in the form of pericardiectomy (resection of the pericardium) might be required.

Why Choose GetWellGo for Pericarditis Treatment?

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We offer:

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  • Medical E-visas
  • Online consultation from recognized Indian experts.
  • Assistance in selecting India's top hospitals for pericarditis treatment.
  • Expert cardiologist/cardiac surgeon with a strong track record of success
  • Assistance during and after the course of treatment.
  • Language Support
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