Medically reviewed by Dr Nabila Laskar, Consultant Cardiologist (GMC 7040901). Pericarditis is inflammation of the pericardium, the protective sac surrounding the heart. It is a relatively common cause of sharp chest pain, particularly in younger adults, and is most often caused by a viral infection. It typically responds well to treatment, though it can recur and occasionally requires specialist input.
The chest pain of pericarditis is typically sharp, stabbing, and positional, often worse on lying flat and improved by sitting forward. This positional quality distinguishes it from the pressure-like chest pain of angina or a heart attack, though the distinction is not always clear-cut and requires formal assessment. Pericarditis may also cause breathlessness, a low-grade fever, and a sensation of the heart pounding. A characteristic friction rub, heard through a stethoscope when the inflamed pericardial layers rub together, is a specific physical sign when present.
The majority of cases are viral in origin, often following a respiratory illness, and no specific virus is identified. Bacterial, autoimmune, and post-cardiac injury causes account for a minority of cases. Pericarditis can also occur following a heart attack (Dressler syndrome) or as a complication of cardiac procedures. In many cases, particularly where no underlying cause is found (idiopathic), the condition resolves fully with appropriate treatment.
ECG frequently shows characteristic changes in acute pericarditis, including saddle-shaped ST elevation across multiple leads, distinct from the localised ST changes of a heart attack. Blood tests typically show raised inflammatory markers. An echocardiogram is performed to assess whether a pericardial effusion (fluid collection around the heart) has developed, which can complicate recovery.
First-line treatment is anti-inflammatory medication, typically combining aspirin or ibuprofen with colchicine. The addition of colchicine significantly reduces the risk of recurrence and is standard in most guidelines. Rest and activity restriction are important during the acute phase. Return to exercise, particularly sport, should follow specialist advice and usually requires a period of complete rest before gradual resumption. Recurrent pericarditis may require specialist management with immunosuppressive agents.
No. Pericarditis affects the sac surrounding the heart, not the coronary arteries supplying the heart muscle. However, both can cause chest pain and ECG changes, and both require formal cardiac assessment to distinguish them.
Most acute cases resolve within four to six weeks with appropriate treatment. Colchicine significantly reduces the risk of recurrence. A minority of patients develop recurrent or chronic pericarditis requiring more specialist management.
Not during the acute phase. Activity restriction is an important part of recovery. Return to exercise, particularly competitive sport, should only happen after a period of complete rest confirmed by specialist review showing resolution of inflammation.
No. You can self-refer directly to The Cardiology Doctors without a GP letter.