---
title: Pericarditis
description: What pericarditis is, why it develops, how it is recognised and when urgent help is needed.
type: disease
aliases:
  - acute pericarditis
  - recurrent pericarditis
sources:
  - tier: guideline
    org: esc
    title: 2025 ESC Guidelines for the management of myocarditis and pericarditis
    year: 2025
    doi: 10.1093/eurheartj/ehaf192
    url: https://doi.org/10.1093/eurheartj/ehaf192
  - tier: guideline
    org: minzdrav-rf
    title: Перикардиты
    year: 2025
    url: https://cr.minzdrav.gov.ru/view-cr/746_2
sources_checked: 2026-10-11
review: null
---

Pericarditis is an inflammatory process in the pericardium, the sac around the heart. Between its layers there is a closed, slit-like cavity that surrounds the heart and normally holds up to 15–50 mL of fluid.<Cite n={2} /> Acute pericarditis is a first episode; it usually shows itself as chest pain and signs of inflammation, and sometimes as a pericardial friction rub and an effusion, a collection of fluid between the layers of the pericardium.<Cite n={2} /> Pericarditis can also occur without an effusion.<Cite n={1} />

<Diagram name="pericarditis">
  <p slot="normal">
    Normally there is a narrow, slit-like cavity between the layers of the pericardium; it
    surrounds the heart and holds up to 15–50 mL of fluid.<Cite n={2} />
  </p>
  <p slot="disease">
    In pericarditis the layers of the pericardium are inflamed. Fluid (an effusion) may collect
    between them, usually only a little, but pericarditis can also occur without an
    effusion.<Cite n={1} />
  </p>
</Diagram>

## Why it happens

<Patient>

In developed countries, most often no cause is found or the pericarditis is caused by a virus.<Cite n={[1, 2]} /> In developing countries the leading cause is tuberculosis.<Cite n={2} /> Pericarditis can also follow heart surgery or occur with autoimmune diseases.<Cite n={2} />

After a first episode pericarditis can come back: this happens in about 20–30% of people within a year and a half.<Cite n={1} />

</Patient>

<Student>

Acute pericarditis is an inflammatory pericardial syndrome with or without a pericardial effusion, with an onset of 4 weeks or less.<Cite n={1} /> The aetiology is varied; in developed countries idiopathic or viral pericarditis predominates (up to 85–90% of patients), while in developing countries the leading cause is tuberculosis, often with HIV infection.<Cite n={2} /> Among non-infectious causes the Russian Ministry of Health guideline names post-cardiotomy pericarditis (8.9–20%) and autoimmune diseases (2–24%).<Cite n={2} />

Recurrent pericarditis is a new episode of acute pericarditis after a symptom-free interval of 4–6 weeks following resolution of the first episode.<Cite n={2} /> Recurrence occurs in about 20–30% of patients within 18 months after a first episode.<Cite n={1} />

</Student>

## Symptoms

<Patient>

The main symptom is chest pain, which 85–90% of people with pericarditis have.<Cite n={1} /> It is usually a sharp pain that gets worse when breathing in and when lying down, and eases when sitting up and leaning forward.<Cite n={1} /> The pain may spread to the shoulders, the shoulder blade and the back.<Cite n={2} />

</Patient>

<Student>

The main presenting symptom is chest pain (85–90% of cases), typically sharp and pleuritic; it improves on sitting up and leaning forward and is made worse by inspiration, lying down and swallowing.<Cite n={1} /> The pain is typically diffuse and radiates to the shoulders, the scapula and the back; because it worsens on inspiration, pleurisy has to be considered in the differential diagnosis.<Cite n={2} />

A pericardial friction rub is heard in no more than 33% of cases.<Cite n={1} /> Cardiac tamponade is a life-threatening compression of the heart by fluid, blood, pus or other material accumulating in the pericardial cavity; its pathognomonic sign is pulsus paradoxus, a fall in systolic blood pressure of more than 10 mm Hg on inspiration during quiet breathing.<Cite n={2} /> Constrictive pericarditis is a late consequence of pericardial inflammation that impairs normal diastolic filling of the heart chambers.<Cite n={[1, 2]} />

</Student>

## How it is diagnosed

<Patient>

The doctor asks about the pain and listens to the heart: in pericarditis a pericardial friction rub can sometimes be heard.<Cite n={1} /> Blood tests for markers of inflammation, an ECG and a heart ultrasound (echocardiography) are done; the ultrasound shows whether there is fluid around the heart.<Cite n={[1, 2]} />

</Patient>

<Student>

Besides chest pain, the diagnosis is supported by a pericardial friction rub (≤33%), a new or worsening pericardial effusion on imaging (up to 60% of cases, generally mild) and raised markers of inflammation such as C-reactive protein (79–90%).<Cite n={1} /> The Russian Ministry of Health guideline counts ECG changes over time among the signs of pericarditis.<Cite n={2} /> The 2025 ESC guideline treats ECG changes as a sign of concomitant myocardial inflammation that warrants investigation for myocarditis.<Cite n={1} />

Echocardiography is the basic imaging method, followed by other techniques.<Cite n={1} /> Transthoracic echocardiography with Doppler is recommended for all patients with pericarditis, both for diagnosis and during follow-up.<Cite n={2} />

</Student>

## How it is treated

<Patient>

Treatment is tailored to the cause of the pericarditis, and the doctor chooses it.<Cite n={1} /> If there are signs of an unfavourable prognosis (for example, a temperature above 38 °C or a large effusion), the person is admitted to hospital and the cause of the disease is looked for.<Cite n={2} />

</Patient>

<Student>

According to the Russian Ministry of Health guideline, even one factor of unfavourable prognosis requires hospital admission and a search for the cause. These factors include a large effusion (an echo-free space of more than 20 mm in diastole), cardiac tamponade, a temperature above 38 °C, a subacute course and no response to non-steroidal anti-inflammatory drugs within 7 days.<Cite n={2} /> Hospitalisation of patients with acute pericarditis and high-risk features allows prompt identification and treatment of potentially life-threatening complications such as tamponade.<Cite n={1} />

The ESC lists omission of colchicine and the use of high doses of corticosteroids with fast tapering as risk factors for recurrence or a chronic course.<Cite n={1} />

</Student>

## When to call an ambulance

Pericarditis can be complicated by cardiac tamponade, compression of the heart by fluid collecting around it. This condition is life-threatening.<Cite n={[1, 2]} /> The main complaints with tamponade or a threat of it are episodes of marked weakness, dizziness, fainting and worsening breathlessness.<Cite n={2} /> If a person with pericarditis has these complaints, call your local emergency number (112 in the EU, 911 in the US and Canada, 999 in the UK). As with any heart condition, call an ambulance for fainting, chest pain or severe breathlessness: this is the site's general safety rule, repeated at the bottom of every page.

If pericarditis is being treated without hospital admission, tell the doctor straight away if the temperature rises above 38 °C or there is no improvement after 7 days of treatment with non-steroidal anti-inflammatory drugs: these are signs of an unfavourable prognosis that call for hospital admission.<Cite n={2} />

<Quiz />