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Pericarditis is a swelling and irritation of the pericardium, the thin sac-like membrane that surrounds your heart. This condition often causes chest pain and other signs and symptoms.

Pericarditis may be acute or chronic. The sharp chest pain associated with acute pericarditis occurs when the pericardium rubs against the heart's outer layer.

Mild cases may improve on their own. Treatment for more severe cases may include medications and surgery. Early diagnosis and treatment is important to reduce the risk of long-term complications.

The most common symptom of pericarditis is sharp, stabbing chest pain behind the breastbone or in the left side of your chest. But a minority of people with this condition describe their chest pain as dull, achy or pressure-like instead, and of varying intensity. The sharp pain may travel into your left shoulder and neck. It often intensifies when you lie down or inhale deeply. Sitting up and leaning forward can often ease the pain. At times, it may be difficult to distinguish pericardial pain from the pain that occurs with a heart attack.

Other signs and symptoms often associated with pericarditis include:

• Shortness of breath when reclining
• Low-grade fever
• An overall sense of weakness, fatigue or feeling sick
• Dry cough
• Abdominal swelling

Under normal circumstances, the two-layered pericardial sac that surrounds your heart contains a small amount of lubricating fluid. But when the pericardium becomes inflamed, the amount of fluid in the sac may increase.

Doctors use the term "pericardial effusion" to describe this fluid collection. The collection of excess fluid in the pericardium can place pressure on your heart. This can squeeze your heart and interfere with its ability to fill adequately and pump blood efficiently, a disorder known as cardiac tamponade.

A variety of infectious and noninfectious disorders can cause pericarditis. Infectious causes of pericarditis are most often due to a virus — such as adenovirus or coxsackievirus — but in some cases, pericarditis is related to bacteria, parasites or fungi. When bacteria cause pericarditis, and pus collects in the pericardial sac, the condition is called purulent pericarditis.

Pericarditis also can develop shortly after a major heart attack due to the irritation of the underlying damaged heart muscle. In addition, a delayed form of pericarditis may occur weeks after a heart attack or heart surgery because of antibody formation. This delayed pericarditis is known as Dressler's syndrome. Many experts believe Dressler's syndrome is due to an autoimmune response, a mistaken inflammatory response by the body to its own tissues — in this case, the heart and pericardium.

Other causes of pericarditis include:

• Widespread systemic inflammatory disorders. These may include lupus and rheumatoid arthritis.
• Trauma. Injury to your heart or chest may occur as a result of a motor vehicle or other accident.
• Other health disorders. These may include kidney failure, AIDS, tuberculosis and cancer.
• Certain medications. Some medications can cause pericarditis, including some blood-thinning medications, antibiotics, drugs that help regulate heart rhythms and medications that control epileptic seizures.

In many cases of pericarditis, the cause of the inflammation isn't known (idiopathic).

Call your doctor if you develop symptoms that may indicate pericarditis, particularly severe chest pain. Many of the symptoms of pericarditis are similar to those of other cardiac and pulmonary conditions. The sooner you visit your doctor, the sooner you can receive proper diagnosis and treatment. For example, although the cause of acute chest pain may be pericarditis, the cause could also be coronary artery disease. Because it's difficult to distinguish these two types of pain, consider any acute chest pain to be a medical emergency and seek immediate care.

Your doctor will likely begin by taking your medical history and asking questions about your chest pain and other symptoms. He or she may ask whether you've recently experienced an upper respiratory infection or a flu-like sickness, and whether the chest pain worsens when you lie down. You may also undergo a physical examination and a review of whether you have or have had medical conditions, such as kidney disease, a recent heart attack or chest trauma. Your doctor may place a stethoscope on your chest to listen for the sounds characteristic of pericarditis, which are made when the pericardium rubs against the outer layer of your heart. Some doctors describe this characteristic noise as an acute pericardial rub.

Your doctor may have you undergo tests that can help determine whether you've had a heart attack, whether fluid has collected in the pericardial sac, or whether there are signs of inflammation. Your doctor may use blood tests to determine if a bacterial or other type of infection is present. You may also undergo one or more of the following diagnostic procedures:

• Chest X-ray. With an X-ray of your chest, your doctor can study the size and shape of your heart. Images of your heart may show an enlarged heart if excess fluid has accumulated in the pericardium.
• Electrocardiogram (ECG). In this test, patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. Certain ECG results may indicate pericarditis.
• Echocardiogram. This test uses high-frequency sound waves to create a picture of your heart and its structures, including fluid accumulation in the pericardium. Your doctor can view and analyze this image on a monitor.
• Computerized tomography (CT). This X-ray technique can produce more-detailed images of your heart and the pericardium than would conventional X-ray studies.
• Magnetic resonance imaging (MRI). This technique uses a magnetic field and radio waves to create cross-sectional images of your heart that can reveal thickening or other changes in the pericardium.

Complications may include:

• Constrictive pericarditis. Some people with pericarditis, particularly those with long-term inflammation and chronic recurrences, can develop permanent thickening, scarring and contracture of the pericardium. In these people, the pericardium loses much of its elasticity and resembles a rigid case that's tight around the heart, which keeps the heart from working properly. This condition is called constrictive pericarditis and often leads to severe swelling of the legs and abdomen, as well as shortness of breath.
• Cardiac tamponade. When too much fluid collects in the pericardium, a condition called cardiac tamponade can develop. Excess fluid puts pressure on the heart and doesn't allow it to fill properly. That means less blood leaves the heart, which causes a dramatic drop in blood pressure. If left untreated, cardiac tamponade can be fatal.

Early diagnosis and treatment of pericarditis usually reduces the risk of the long-term complications.

Deciding upon treatment for pericarditis will likely involve consideration of the underlying cause as well as the severity. Mild cases of pericarditis may get better on their own without treatment. People with more-severe cases may need to be hospitalized for treatment.

Rest and medications
Your doctor may recommend bed rest until you're feeling better. He or she may also prescribe anti-inflammatory drugs, such as aspirin, ibuprofen and indomethacin, to reduce inflammation and relieve pain. If your pain is severe, you might need stronger pain medications, such as a narcotic, for a short time. Doctors occasionally prescribe corticosteroid drugs, such as prednisone, to curtail inflammation. However, corticosteroids have potential side effects, and there's a risk of rebound inflammation after you stop taking the drug.

Acute episodes of pericarditis typically last from one to three weeks, but future episodes can occur. About one in five people with pericarditis have a recurrence within months of the original episode. People who have repeated episodes of pericarditis are often treated with an anti-inflammatory drug called colchicine.

Hospitalization sometimes necessary
You'll likely need hospitalization if your doctor suspects cardiac tamponade. When cardiac tamponade is present, you may undergo a technique called pericardiocentesis. In this procedure, a doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You'll receive a local anesthetic before undergoing pericardiocentesis, which is often done with echocardiogram and ultrasound guidance. This drainage may continue for several days during the course of your hospitalization.

If you're diagnosed with constrictive pericarditis, you may need to undergo a surgical procedure (pericardiectomy) to remove the entire pericardium that has become rigid and is compromising the functioning of your heart.

When a bacterial infection is the underlying cause of pericarditis, you'll be treated with antibiotics and drainage if necessary.