Recurrent Pericarditis

What is recurrent pericarditis?

Recurrent pericarditis is when you develop pericarditis for a second time after having no symptoms for at least four weeks.

Pericarditis is an inflamed pericardium, a sac-like organ with two thin layers of tissue that surround the heart to hold it in place and help it work. A small amount of fluid keeps the layers separate and decreases the friction between them as the heart beats. But in some people with this condition, these tissues become swollen and irritated. This can cause sharp chest pain and may lead to fluid buildup around the heart that causes discomfort. In most cases, pericarditis is mild and gets better on its own without treatment.

Recurrent pericarditis occurs in 15% to 50% of people with pericarditis in the U.S., or about 40,000 people. Pericarditis is most common in men 16 to 65 years old, but it can affect anybody at any age. Recurrent pericarditis occurs more frequently in women, who are more susceptible to autoimmune conditions that can irritate the pericardium. A recent study found that about 5% of people seeking treatment in emergency departments for chest pain had acute pericarditis.

Other types of pericarditis include:

• Acute pericarditis (less than four to six weeks)
• Incessant pericarditis (persistent symptoms more than four to six weeks but less than three months despite therapy)
• Constrictive pericarditis (lasting for more than 3 months, an often chronic form of heart failure in which tissue forms and causes the pericardium to lose its elasticity)

Download infographic: Recurrent Pericarditis (PDF)

What are the symptoms of recurrent pericarditis?

Symptoms of recurrent pericarditis include:

• Dull ache, pressure or stabbing pain in the chest that gets worse when coughing, taking deep breaths or lying down (some people mistake the pain for a heart attack), improved by sitting up and leaning forward
• Shortness of breath or difficulty breathing
• Heart palpitations or a faster than normal heartbeat
• Low-grade fever
• Cough
• Swollen abdomen, legs or feet
• Low blood pressure symptoms such as lightheadedness, dizziness or fainting

What causes recurrent pericarditis?

While there’s no single cause for recurrent pericarditis, it often develops in people whose initial bout of pericarditis isn’t treated adequately. Long-term use of corticosteroids, such as prednisone, may also be associated with recurrences.

In up to 20% of cases, viral illnesses such as herpes, influenza, adenovirus, enterovirus, Epstein Barr virus (EBV), or hepatitis viruses (A, B, C) may also cause recurrent pericarditis.

Other potential causes include:

• Autoimmune conditions such as lupus, scleroderma and rheumatoid arthritis
• Complications from a heart attack or heart surgery
• Health problems such as kidney failure, cancer, HIV/AIDS or tuberculosis
• Bacterial, fungal and parasitic infections (most common in people with compromised immune systems)
• Certain medications, such as phenytoin (an anti-seizure medicine), warfarin and heparin (blood thinners), and procainamide (prescribed for irregular heartbeats) 

The cause of recurrent pericarditis often can’t be identified.

How is recurrent pericarditis diagnosed?

Your primary care doctor, pediatrician or internist often diagnose and treat recurrent pericarditis. Depending on your age and medical conditions, a cardiologist or infectious disease specialist may also be involved.

If your doctor believes you may have pericarditis, they’ll listen to your heart for rubbing sounds that often occur in people with the condition. Doctors may use the following tests to confirm the diagnosis:

• Blood test: May reveal the presence of white blood cells, C-reactive protein and other signs of inflammation. It may also detect signs of heart injury such as troponin.
• EKG (electrocardiogram): Provides a picture of your heart’s electrical activity and certain results may suggest pericarditis.
• Chest X-ray: Takes pictures of the heart, lungs and blood vessels inside your chest. An X-ray can show whether the heart is enlarged due to excess fluid in the pericardium. It may also reveal signs of infection, sarcoidosis or malignancies that may cause pericarditis.
• Echocardiogram: Sound waves create pictures of your heart’s size, shape and how it’s working. This can reveal fluid accumulation in the pericardium.
• Cardiac CT (computed tomography): A type of X-ray that takes a clear, detailed picture of your heart.
• Cardiac MRI (magnetic resonance imaging): Magnets and radio waves create detailed images of your organs and tissues, which can reveal changes in the pericardium.

How is recurrent pericarditis treated?

Recurrent pericarditis is usually treated with aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS). The anti-inflammatory drug colchicine may improve the effectiveness of those drugs and is often prescribed with them.

When NSAIDs and colchicine don’t lead to a complete remission, low to moderate doses of corticosteroids such as prednisone may also be prescribed. Because steroids have been linked with a higher risk of recurrence, they’re typically used in people who can’t tolerate NSAIDs or in those who are pregnant or have conditions such as autoimmune disease.

Immunosuppressants and interleukin 1 blockers, which neutralize pro-inflammatory molecules, may also be prescribed for the 5% to 10% of patients who don’t respond to medications.

Your doctor may also drain excess fluid from the pericardium or, as a last result, remove it partially or entirely.

Outlook

For most people, recurrent pericarditis can be safely managed at home and rarely leads to death. But it can cause potentially life-threatening complications such as loss of the pericardium’s elasticity (constrictive pericarditis) and a buildup of fluid in the pericardium (cardiac tamponade). Some people with pericarditis may also have pericardial thickening.

If you have one of the following symptoms, your doctor may admit you to the hospital for treatment:

• Fever of 100.4 or higher
• Continued pericarditis after one week of treatment with anti-inflammatory medications
• Heart damage

If you feel chest pain of any type, immediately call 911, because it may be a sign of a heart attack. If you have recurrent pericarditis, be sure to talk to your doctor about your symptoms and treatment options. 

Download our Answers by Heart Sheet: What is Recurrent Pericarditis? (PDF)