Pericarditis Pain? Why Your Heart Is Inflamed & Medically Approved Next Steps

Pericarditis is inflammation of the pericardium—the thin, two-layered sac that surrounds your heart. When this lining becomes irritated or swollen, it can cause sharp chest pain and other uncomfortable symptoms.

If you're experiencing chest pain, it's natural to feel concerned. The key is understanding what pericarditis is, what causes it, how it's treated, and when you need urgent care. Let's walk through it clearly and calmly.

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What Is Pericarditis?

The heart sits inside a protective sac called the pericardium. This sac:

• Keeps the heart in position
• Prevents excessive movement
• Reduces friction as the heart beats

When the pericardium becomes inflamed, the layers can rub against each other. That friction causes pericarditis pain, which can range from mild to severe.

Pericarditis can be:

• Acute – sudden onset, lasting days to weeks
• Recurrent – symptoms return after recovery
• Chronic – lasting longer than three months
• Constrictive – rare, but serious scarring that affects heart function

Most cases are acute and improve with proper treatment.

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What Does Pericarditis Pain Feel Like?

The most common symptom of pericarditis is chest pain. It often has distinct features:

• Sharp or stabbing pain
• Pain in the center or left side of the chest
• Pain that may spread to the neck, shoulder, or back
• Worse when lying flat
• Worse with deep breaths
• Improved when sitting up and leaning forward

This position-related pain is a key feature of pericarditis.

Other symptoms may include:

• Low-grade fever
• Fatigue
• Shortness of breath
• Heart palpitations
• Mild cough
• Swelling in the legs (in more severe cases)

Because chest pain can also signal a heart attack, it is critical to seek emergency care if:

• Pain is crushing or pressure-like
• Pain spreads to the arm or jaw
• You feel faint or sweaty
• You have nausea or vomiting
• You have risk factors for heart disease

Never assume chest pain is harmless.

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What Causes Pericarditis?

In many cases, doctors cannot identify a clear cause. However, known triggers include:

1. Viral Infections (Most Common)

Viruses such as:

• Common cold viruses
• Influenza
• COVID-19
• Coxsackievirus

2. Bacterial Infections (Less Common but Serious)

3. Autoimmune Conditions

• Lupus
• Rheumatoid arthritis
• Other inflammatory disorders

4. After a Heart Attack or Heart Surgery

Inflammation can develop days to weeks after a heart event.

5. Kidney Failure

6. Cancer or Radiation Therapy

7. Certain Medications

Often, acute pericarditis develops after a recent viral illness.

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How Is Pericarditis Diagnosed?

If you go to the doctor with chest pain, they will focus on ruling out life-threatening causes first.

Diagnosis may include:

• Physical exam – A provider may hear a "pericardial friction rub" with a stethoscope.
• Electrocardiogram (ECG/EKG) – Looks for characteristic electrical changes.
• Blood tests – Check for inflammation and heart damage markers.
• Echocardiogram (ultrasound of the heart) – Detects fluid buildup.
• Chest X-ray
• Cardiac MRI or CT scan (in select cases)

One potential complication is pericardial effusion, which is fluid buildup around the heart. If that fluid becomes excessive, it can lead to cardiac tamponade, a life-threatening emergency. Fortunately, this is uncommon in uncomplicated acute pericarditis.

If you're experiencing sharp chest pain that worsens when lying down or improves when leaning forward, you can use Ubie's free AI-powered Acute Pericarditis symptom checker to evaluate your symptoms and help determine whether you should seek immediate medical attention.

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Treatment for Pericarditis

Most cases of acute pericarditis are treatable and resolve within a few weeks.

First-Line Treatment

Doctors typically prescribe:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
• Colchicine, which reduces inflammation and lowers recurrence risk

Colchicine has significantly improved long-term outcomes and is commonly used for several months.

If Symptoms Are Severe or Persistent

• Corticosteroids (in select cases, usually if NSAIDs fail or autoimmune disease is present)
• Treatment of underlying cause (e.g., antibiotics for bacterial infection)

Hospitalization May Be Needed If:

• High fever
• Large fluid buildup
• Signs of tamponade
• Immune system suppression
• Trauma
• Failure to improve with standard treatment

Most otherwise healthy individuals recover fully with outpatient treatment.

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How Long Does Pericarditis Last?

• Acute cases: 1–3 weeks
• With treatment: often improves within days
• Recurrent pericarditis: may relapse weeks to months later

About 15–30% of people with acute pericarditis may experience recurrence. Taking colchicine as prescribed reduces that risk.

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Lifestyle Tips During Recovery

While healing, consider:

• Resting and limiting strenuous activity
• Avoiding intense exercise until cleared by your doctor
• Staying hydrated
• Taking medications exactly as directed
• Following up as recommended

Athletes are usually advised to avoid competitive sports for several months.

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When Is Pericarditis Dangerous?

Most cases are manageable. However, serious complications can occur:

1. Cardiac Tamponade

Fluid buildup compresses the heart, preventing it from pumping effectively. This is a medical emergency.

Symptoms include:

• Severe shortness of breath
• Lightheadedness
• Rapid heart rate
• Low blood pressure

2. Constrictive Pericarditis

Chronic scarring makes the pericardium stiff, restricting heart function. This is rare but may require surgery.

The key is early recognition and proper treatment.

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Pericarditis vs. Heart Attack: Key Differences

Feature	Pericarditis	Heart Attack
Pain type	Sharp, stabbing	Pressure, squeezing
Worse lying flat	Yes	No
Better leaning forward	Yes	No
Triggered by exertion	Not usually	Often
Emergency?	Sometimes	Always

If there's any doubt, treat chest pain as an emergency.

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Who Is at Higher Risk?

You may have higher risk of pericarditis if you:

• Recently had a viral illness
• Have an autoimmune disease
• Recently had heart surgery
• Have kidney failure
• Are male (slightly more common in men ages 20–50)

Still, it can happen to anyone.

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When Should You Speak to a Doctor?

You should seek emergency care immediately if you have:

• New or severe chest pain
• Shortness of breath
• Fainting
• Symptoms of shock

You should schedule a prompt medical evaluation if you have:

• Persistent sharp chest pain
• Fever with chest discomfort
• Pain that improves leaning forward
• Symptoms lasting more than a day

Do not try to diagnose chest pain on your own. Even if it turns out to be pericarditis and not a heart attack, proper testing is essential.

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The Bottom Line

Pericarditis is inflammation of the heart's protective lining. It commonly causes sharp chest pain that worsens when lying down and improves when sitting forward. Most cases are linked to viral infections and respond well to anti-inflammatory medications and colchicine.

While many cases are mild and resolve fully, complications can occur. Chest pain should never be ignored.

If you're unsure whether your chest pain symptoms align with Acute Pericarditis, Ubie's free AI-powered symptom checker can help you understand your condition and determine the appropriate level of care needed—especially if symptoms are severe, worsening, or feel different from anything you've experienced before.

Your heart health is not something to guess about. When in doubt, get evaluated.