Pericarditis
Inflammation of the pericardium, the thin sac surrounding the heart. It typically causes sharp chest pain that is worse lying down and better sitting forward, often after a viral infection. Most cases settle with anti-inflammatory treatment, but the chest pain always needs assessment to exclude a heart attack.
What it is
Pericarditis is inflammation of the pericardium, the double-layered sac that surrounds the heart. It is one of several causes of chest pain, and importantly one that must be told apart from a heart attack. The classic pain is sharp and located behind the breastbone, characteristically worse when lying flat or breathing in and relieved by sitting up and leaning forward — a pattern that helps distinguish it. The commonest cause is a viral infection, and it often follows a cold or flu-like illness; other causes include other infections, autoimmune diseases (such as lupus or rheumatoid arthritis), kidney failure, after a heart attack or heart surgery, and sometimes cancer. On examination a doctor may hear a characteristic rubbing sound, and the ECG shows typical changes. Blood tests show inflammation (a raised CRP and ESR) and sometimes a mildly raised troponin if the nearby heart muscle is also involved (myopericarditis). A complication to watch for is a build-up of fluid around the heart (pericardial effusion), which occasionally becomes large enough to compress the heart (cardiac tamponade) — a medical emergency. Most acute pericarditis is treated with anti-inflammatory medicines (often with colchicine) and settles, though it can sometimes recur.
Key lab markers
- CRP / hs-CRP — inflammation markers; typically raised and useful for tracking response to treatment.
- ESR — another inflammation marker, often raised.
- Troponin — may be mildly raised if the heart muscle is also inflamed (myopericarditis); central to distinguishing from a heart attack.
- Full blood count — may show signs of infection.
- Kidney function and autoimmune markers — to look for an underlying cause where relevant.
Symptoms
- Sharp chest pain, worse lying flat and on breathing in, relieved by sitting forward
- Pain that may spread to the neck, shoulder or back
- A preceding cold or flu-like illness in many cases
- Low-grade fever
- Fatigue and feeling generally unwell
- Breathlessness, especially if fluid builds up
- Palpitations in some cases
Related lab panels
When to discuss with a doctor
Any new chest pain needs prompt medical assessment — the priority is to distinguish pericarditis from a heart attack and other serious causes, which cannot be done reliably at home even though the pain of pericarditis has characteristic features (sharp, worse lying flat, better sitting forward). Seek urgent care for severe or persistent chest pain, chest pain with breathlessness, fainting, or a feeling of pressure, and be aware that increasing breathlessness or feeling very unwell can signal fluid building up around the heart, which is an emergency. Once diagnosed, most pericarditis responds well to anti-inflammatory treatment, with CRP followed to track recovery. Mediora.AI can show a raised inflammation pattern (CRP, ESR) with any troponin change that fits pericarditis, but chest pain always needs urgent in-person evaluation and the diagnosis belongs with your doctor.