Hope for Pericarditis Patients: Symptoms, Treatments and Research

When the protective lining around the heart becomes inflamed, the result is a condition called pericarditis. Its most common symptom – sharp chest pain – is hard to ignore. While many cases are mild and improve with treatment, others return repeatedly and interrupt daily life. The good news is that research is bringing new hope. Some of the latest cardiovascular studies at the Minneapolis Heart Institute Foundation (MHIF) have focused on pericarditis, helping doctors better understand the condition and paving the way for new treatments.

Pericarditis is characterized by swelling and irritation of the pericardium – the thin, saclike tissue surrounding the heart. When these layers of irritated tissue rub against each other, patients feel pain. Sharp chest pain is the most common complaint; however, some patients experience a dull, achy pain or pressure instead. This pain is often felt behind the breastbone or on the left side of the chest, but may spread throughout the shoulders and neck. It typically gets worse when coughing or lying down and improves when sitting up.

Although pain is the most common symptom, patients with pericarditis may also experience any of the following: 

• Cough
• Fatigue
• Swelling of the legs or feet
• Heart palpitations
• Shortness of breath when lying down
• Swelling in the abdomen
• Low-grade fever 

Many times, these symptoms are mild and go away without treatment, but in other cases pericarditis is recurring and more severe.

Doctors classify pericarditis by its symptom persistence in order to help determine the best treatment. Acute pericarditis happens as a single episode of symptoms (sometimes called a flare) but doesn’t last more than four weeks. Up to 30% of people with acute pericarditis will develop recurrent pericarditis within the first year – in other words, they will have additional flares following a symptom-free period of more than four weeks.

Recurrent pericarditis is caused by autoinflammation (an abnormal inflammation) that attacks the pericardium. Additional flares can occur if the first pericarditis episode isn’t treated or if the treatment doesn’t work well enough. In some cases, pericarditis can be linked to an autoimmune illness like lupus or rheumatoid arthritis; sometimes, doctors can’t pinpoint the exact cause.

Recurrent cases of pericarditis can limit physical activity, impact quality of life, and lead to frequent emergency department visits and hospitalizations. Fortunately, research continues to uncover new treatments. Some medicines reduce symptoms like pain and swelling, while others work to stop pericarditis from coming back. Your doctor will help you weigh the benefits and side effects, and choose the best option for you.

• NSAIDs (like ibuprofen): Usually the first medicine doctors try. They can help address symptoms by bringing down swelling and reducing pain.
• IL-1 inhibitors: Used when pericarditis recurs. They block the body’s process that causes repeat flares to prevent future episodes. MHIF’s Dr. David Lin has led research to pave the way for some of these medications.
• Colchicine: Used for both first-time and recurrent episodes. Like NSAIDs, it can help calm swelling.
• Corticosteroids (steroids): Used to lower swelling. Steroids are typically considered when other medicines don’t work, due to safety concerns with long-term use.

Lifestyle modifications can also help reduce the risk of pericarditis episodes and help relieve symptoms.  For example, using positioning tools (like a wedge under your mattress) to elevate the top part of your body can help lessen chest pain. In other cases, people find success by avoiding triggers that can contribute to recurrent pericarditis. Examples may include alcohol, excess heat, stress or periods of elevated heart rate. Some find meditation and breathing exercises (known to lower heart rate and blood pressure) helpful.

Living with pericarditis can be painful and disruptive, but the right care can help patients manage symptoms and return to an active lifestyle. Research at MHIF continues to open doors to new therapies and treatments. These advances bring hope for relief and renewed quality of life.