9 Symptoms of Pericarditis—Heart Inflammation That Can Feel Like a Heart Attack
Two medical doctors explain how to recognize this illness that's gained attention in connection with COVID-19.
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Pericarditis is a relatively rare condition, affecting only about 28 people per 100,000 each year in the US. One of these was Ana Martindale, of Bellingham, WA. On an ordinary night in 2018, Martindale was watching TV with her partner Julie when suddenly she felt stabbing pains in her chest and immense pressure. As sweat poured down her face and she struggled to breathe, the 51-year-old EMT recognized the telltale warning signs of a heart attack and instructed Julie to call 911—missing the more subtle symptoms of pericarditis.
The hospital admitted Martindale. Over the next three days, doctors ran every test in the book on her heart…but the only thing that came back was slightly elevated troponin, a protein that can indicate damage to the heart muscle. Without any additional signs, they declared it hadn’t been a heart attack and sent her home.
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A month later, Martindale had a similar attack with similar results—then two months later, another attack of chest pain. Desperately worried and frustrated, Martindale decided to go to a specialist at a nearby university hospital. There, she finally got her answer: Transient viral pericarditis.
“It was an answer, but it wasn’t a great one,” she says. “I had no idea what that meant for my health going forward.”
Thankfully, doctors were able to treat the viral infection and Martindale recovered completely. Still, years later, she remains frustrated by the experience and how long it took her to get a proper diagnosis and treatment.
Martindale’s experience isn’t unique, says Ronald G. Grifka, MD, a cardiologist and chief medical officer at the University of Michigan Health-West. “Pericarditis and its sister illness, myocarditis, are relatively common but poorly understood, largely because they can have many different causes and symptoms that can vary widely from person to person,” Dr. Grifka says.
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What is pericarditis?
The pericardium is a double-layered, sac-like membrane that surrounds the heart, protecting it and helping it to function properly. Pericarditis is a medical condition in which the pericardium becomes inflamed.
In some cases, the inflammation of the pericardium can cause an accumulation of fluid in the pericardial sac, a condition known as pericardial effusion. This fluid puts pressure on the heart and restricts its ability to function. If the effusion is significant, it can lead to cardiac tamponade, which is a medical emergency and can be fatal.
Pericarditis can be acute, meaning it comes on suddenly and lasts for a few days or weeks; or it can be chronic, like Martindale’s, lasting for months or even years.
Causes of pericarditis
Dr. Grifka says the most common cause of pericarditis is a viral infection, like what Martindale experienced. “For some people, a virus infection may cause inflammation of the nose and mouth (a cold); others have inflammation of the GI tract (vomiting and diarrhea). However, in some people that virus will cause inflammation of the heart muscle (myocarditis) or lining around the heart (pericarditis),” he explains. “Sometimes there are none or minimal symptoms, but sometimes it can progress to be severe or life-threatening.”
Viruses aren’t the only culprit, says Amy Shah, MD, double-board-certified medical doctor and author. Because it’s inflammatory, pericarditis can be caused by a number of factors that induce inflammation, including viral or bacterial infections, autoimmune disorders, kidney failure, other illnesses, injury to the chest, or certain medications, she explains.
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Symptoms of pericarditis
The most common among symptoms of pericarditis is chest pain, which is often sharp and may be felt in the center or left side of the chest. “It can feel very similar to heart attack pain, and we always recommend patients seek immediate medical care if they experience this,” says Dr. Shah.
In cases of pericarditis caused by an infection, a fever can be an early warning sign, says Dr. Shah. A fever occurs when the immune system is activated to fight off the infection or inflammation. The fever associated with pericarditis is typically low-grade, meaning it is usually below 101°F (38.3°C) but it can go higher, depending on the severity of the infection.
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A feeling of all-over aches or muscle soreness often accompanies a fever and also numbers among the symptoms of pericarditis, says Dr. Grifka. Your body may also feel achy due to the poor circulation of blood.
When the heart muscle is inflamed, it does not contract, or “squeeze,” as strongly. When your heart can’t function properly, neither can the rest of your body—and that manifests as an overwhelming feeling of exhaustion, tiredness, and fatigue, says Dr. Grifka.
Similarly, when your heart can’t pump properly, it’s unable to circulate oxygen through your blood as efficiently and you may feel difficulty breathing. Dr. Grifka says this sensation can range from a shortness of breath during exertion to an extreme feeling of being unable to breathe.
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Rapid heart beat
Tachycardia, or a “racing heart,” can happen as the heart muscle tries to beat faster, in an effort to get more oxygen to the body. This feeling can be mistaken as anxiety or a panic attack, and you may be tempted to write it off.
Don’t ignore a rapid heart beat, says Dr. Shah: It’s important to seek medical attention if you feel this in conjunction with other symptoms on this list.
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It’s not the most common of the symptoms of pericarditis but some people—especially those with chronic pericarditis—may experience a dry cough, meaning they are not coughing up mucus or blood. The inflammation can irritate the nearby tissues, including the lungs, and trigger a cough reflex. In addition, the sharp pain associated with pericarditis can cause you to take shallow breaths, leading to a coughing reflex.
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Swelling in the lower body
When your heart isn’t functioning efficiently, it can cause a backup of blood in the veins and capillaries of the legs, says Dr. Grifka, adding that this is a major red flag of pericardial effusion. This symptom of pericarditis is more common in people who have pericarditis as a complication of other illnesses, like liver or kidney disease.
Dizziness or fainting
Another sign of low oxygen is feeling light-headed, dizzy, or even fainting and losing consciousness, says Dr. Shah.
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Treatment for pericarditis
Treatment for pericarditis depends on the underlying cause and may include medications to reduce inflammation and pain, rest, and in some cases, procedures to remove excess fluid from the pericardium.
Usually after several days, the symptoms start to resolve without any treatment or may have some relief with anti-inflammatory medicines (ibuprofen, naproxen, colchicine), Dr. Grifka explains. “On rare occasions, the heart muscle can be damaged by the virus and will not recover normal function, resulting in persistent and progressive symptoms due to very weak heart function,” he says. “This is why it’s important to note if you have the symptoms mentioned: If they persist for more than two or three days, or become progressively more severe, you should seek medical treatment.”
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This condition can’t be totally prevented, but there are some things you can do to lessen your risk. “If you follow precautions to decrease your viral infection risk, you will also decrease the risk of these conditions,” says Dr. Shah. This includes proper handwashing techniques, wearing masks, getting vaccinated against common illnesses and taking other steps to avoid infections.
Ronald G. Grifka, MD, FAAP, FACC, FSCAI, cardiologist and Chief Medical Officer, University of Michigan Health-West
Amy Shah, MD, double-board-certified medical doctor and nutrition expert with training from Cornell, Columbia, and Harvard Universities. She is the author of I'M SO EFFING HUNGRY: Why We Crave What We Crave—and What to Do About ItNational Library of Medicine: "Pericarditis"