Pericarditis
Pericarditis: A Complete Patient Guide
Pericarditis is inflammation of the pericardium, the thin double-layered sac that surrounds the heart. The inflamed layers rub against each other and can cause sharp chest pain, often after or alongside a viral illness. It is one of the commonest non-coronary causes of chest pain, and it is usually not dangerous and responds well to treatment, although it can recur.
Most cases in the UK are idiopathic or viral (no specific cause is found). Other causes include heart attack or heart surgery, autoimmune conditions such as lupus and rheumatoid arthritis, kidney failure, cancer, tuberculosis (less common in the UK) and some medicines. Sometimes fluid accumulates around the heart (a pericardial effusion), and the heart muscle can also be involved (myopericarditis).
The 2025 ESC guideline on myocarditis and pericarditis describes how acute pericarditis should be diagnosed, how colchicine with an anti-inflammatory is the treatment of choice, and how recurrences are managed. Most people recover fully within weeks.
The chest pain of pericarditis is typically distinctive, and recognising its pattern helps tell it from a heart attack.
Typical symptoms
Sharp chest pain in the centre or left of the chest, which worsens with deep breathing, coughing or lying flat
Pain that eases when sitting up and leaning forward
Pain that may spread to the shoulder, neck or back (particularly the left trapezius ridge)
A low-grade fever, tiredness, and a recent cold or flu-like illness
Other symptoms
Breathlessness, particularly if fluid has built up around the heart
Palpitations
Dry cough
Signs your doctor may find
A scratchy sound called a pericardial rub heard through the stethoscope, changes on the ECG, or fluid on an echocardiogram.
In many people no cause is found, and a viral infection is presumed.
Recognised causes
Viral infections, including coxsackievirus, adenovirus and COVID-19, are the most frequent identifiable cause
Autoimmune and inflammatory conditions, such as lupus, rheumatoid arthritis and autoinflammatory syndromes
After a heart attack, heart surgery or procedures (post-cardiac injury syndrome, including Dressler syndrome)
Kidney failure (uraemic pericarditis)
Cancer or radiotherapy to the chest, and tuberculosis
Chest injury, and some medicines
Factors linked to complications
Fever above 38°C, symptoms developing gradually, a large effusion, tamponade, failure to respond to anti-inflammatory medicines or taking blood thinners are features that suggest a need for closer assessment, and sometimes admission.
New sharp chest pain should always be assessed, because pericarditis can look similar to a heart attack.
Arrange a prompt assessment if you have:
Chest pain that is sharp, worse on breathing in or lying flat, and eases leaning forward
Chest pain with a fever or following a recent viral illness
A known diagnosis of pericarditis with symptoms that return, particularly when you stop treatment
Breathlessness or ankle swelling after a heart attack, heart surgery or chest radiotherapy
Call 999 immediately if you have:
Severe or crushing chest pain, or pain with sweating and breathlessness
Severe breathlessness, feeling faint, or collapse
Rapid pulse with low blood pressure or feeling very unwell, which could signal fluid compressing the heart
Diagnosis is based on a combination of symptoms and test findings. The ESC guideline recommends diagnosing acute pericarditis when at least two of four features are present.
The four diagnostic features
Typical pericarditic chest pain
A pericardial rub on examination
Characteristic ECG changes, such as widespread ST elevation and PR depression
A new or worsening pericardial effusion on echocardiography
1. ECG
An ECG looks for the typical widespread changes of pericarditis and excludes a heart attack.
2. Blood tests
Inflammatory markers (CRP), a blood count, kidney function and troponin (which may be mildly raised if the heart muscle is also inflamed) are checked, with tests for autoimmune disease or infection when indicated.
3. Echocardiogram
An echocardiogram detects fluid around the heart, checks for tamponade and assesses the pumping function of the heart.
4. Further imaging
Chest X-ray, CT or cardiac MRI may be used in complicated, recurrent or uncertain cases to show inflammation, scarring or constriction of the pericardium and to check whether the heart muscle is involved.
Most people are treated at home. The aim is to settle inflammation, relieve pain and prevent recurrence.
First-line treatment
An anti-inflammatory medicine (aspirin or ibuprofen/naproxen at full dose, with stomach protection) until symptoms have settled and CRP has normalised, followed by gradual tapering
Colchicine, usually for 3 months, which reduces symptoms and halves the chance of recurrence
Rest from strenuous exercise until symptoms have resolved and inflammatory markers are normal
If treatment is not enough
Corticosteroids are avoided as first-line treatment because they raise the risk of recurrence, and are used cautiously in selected cases, at low dose, when other medicines cannot be used
For recurrent pericarditis, longer colchicine courses are used, and immunosuppressive options such as interleukin-1 blockers (anakinra, rilonacept) may be offered by specialist teams
Complications
Pericardial effusion and tamponade: fluid is drained (pericardiocentesis) if the heart is compressed
Constrictive pericarditis: a rare late scarring that may need surgery
Complete the full course of colchicine and anti-inflammatory tablets, and taper as advised. Stopping early increases the chance of recurrence.
Avoid strenuous exercise until your doctor confirms symptoms and inflammatory markers have settled. Athletes usually need a longer period and specialist clearance.
Protect your stomach: take anti-inflammatories with food and any acid-protection tablet prescribed.
Colchicine: tell your doctor if you have diarrhoea. Avoid grapefruit juice, and check interactions with other medicines.
Return of pain: contact your doctor early, as prompt treatment can stop a recurrence developing.
Work and driving: most people return to normal activity within weeks.
Support is available from the British Heart Foundation and the NHS.
Most people with acute pericarditis make a full recovery within a few weeks with treatment.
Around 15–30% of people have a recurrence, which is why colchicine is used and treatment is tapered slowly.
Recurrent pericarditis can be frustrating but is rarely dangerous, and specialist treatments are available.
Serious complications, including tamponade or constrictive pericarditis, are uncommon.
If the heart muscle was also inflamed (myopericarditis), follow-up with echocardiography or MRI may be recommended.
Pericarditis is inflammation of the sac around the heart, often after a viral illness.
The classic pain is sharp, worse on breathing in or lying flat, and eased by leaning forward.
Diagnosis needs two of four features: typical pain, a rub, ECG changes or effusion.
It can look like a heart attack, so new chest pain needs assessment.
Treatment is an anti-inflammatory plus colchicine (usually 3 months), and rest from strenuous exercise.
Steroids are avoided as first choice because they increase recurrence.
Around one in five people have a recurrence, and specialist treatments exist.
Most people recover fully, and serious complications are uncommon.
Guidelines and sources
This page follows current European guidance and key trial evidence:
Schulz-Menger J et al. 2025 ESC Guidelines for the management of myocarditis and pericarditis. European Heart Journal 2025;46:3952-4041.
Imazio M et al. A randomized trial of colchicine for acute pericarditis (ICAP). New England Journal of Medicine 2013;369:1522-1528.
These are the questions patients most often ask about pericarditis.
What is pericarditis?
Inflammation of the thin sac around the heart, which causes sharp chest pain that is often worse on breathing in or lying flat and eased by leaning forward.
What does pericarditis chest pain feel like?
Typically a sharp, stabbing pain in the centre or left of the chest, worse on deep breaths, coughing or lying down, and easier sitting forward. It can spread to the shoulder or neck.
How do I tell pericarditis from a heart attack?
It can be difficult, and you should not try to decide yourself. Heart attack pain is usually a pressure or heaviness, not changed by breathing or position. Call 999 for severe chest pain, and a doctor will tell the difference using an ECG and blood tests.
What causes pericarditis?
Most often a viral infection or no cause found. Others include autoimmune disease, a heart attack or heart surgery, kidney failure, cancer and some medicines.
How long does pericarditis last?
Symptoms often settle within days to a couple of weeks with treatment, and treatment usually continues for several weeks to 3 months. Some people have recurrences.
Is pericarditis serious?
Usually not. Most people recover fully. Serious problems such as fluid compressing the heart (tamponade) are uncommon but need urgent treatment.
What is the treatment for pericarditis?
An anti-inflammatory such as aspirin or ibuprofen, plus colchicine for about 3 months, and avoiding strenuous exercise until recovered.
Can pericarditis come back?
Yes, in around 15–30% of people. Colchicine reduces the risk. If it recurs, longer treatment or specialist medicines can be used.
When can I exercise again after pericarditis?
Not until symptoms have gone and blood inflammation markers are normal, which usually takes weeks. Athletes typically wait longer and need medical clearance.
Can I have a private assessment for chest pain?
Yes. A telephone, video or face-to-face consultation in Peterborough or Corby can assess chest pain, with an ECG and echocardiogram arranged where appropriate. Severe chest pain needs 999.
- Is my chest pain pericarditis, and have a heart attack and inflammation of the heart muscle (myocarditis) been ruled out?
- What is the most likely cause in my case, and do I need any further tests to look for it?
- Do I need an echocardiogram, and is there any fluid around my heart?
- Which anti-inflammatory medicine should I take, at what dose, and for how long before I reduce it?
- Should I take colchicine, and what side effects should I watch for?
- Do I need a stomach-protecting medicine while I take aspirin or ibuprofen?
- When can I return to work, driving and exercise, and how will we decide it is safe?
- How likely is it to come back, and is there anything that lowers that risk?
- Which symptoms should make me call 999 or seek urgent help?
- How often will I need follow-up, and will I need repeat blood tests or scans to check my recovery?
How the pericardium is affected
The pericardium is a thin, two-layered sac around the heart. In pericarditis the layers become inflamed. If extra fluid collects (a pericardial effusion), a large or fast build-up can press on the heart and needs urgent care.
What the pain is typically like
Pericarditis pain is classically sharp, and changes with position and breathing. Any new chest pain still needs proper assessment, because it can look like a heart attack.
Treatment and recovery
Most people recover fully with anti-inflammatory medicine and colchicine, followed by a slow taper. Finishing the full course lowers the chance of it returning.
If you have sharp chest pain that is worse on breathing or lying flat, you may benefit from a telephone consultation or video consultation, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment. Severe chest pain needs a 999 call.
Investigations such as ECG, echocardiography and cardiac MRI may be recommended.
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Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last updated: . This page is for general information and does not replace personal medical advice.