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Chronic Pericarditis


What is chronic pericarditis?

Chronic pericarditis is inflammation of the pericardium for longer than 3 months. The pericardium is the thin sac that surrounds your heart. A small amount of clear fluid between the heart and the sac allows the heart to beat easily. With pericarditis, the amount of fluid increases and may contain pus. This can lead to problems with the way that your heart beats.

What causes chronic pericarditis?

The cause may not be known. Pericarditis may be caused by any of the following:

  • Damage to the sac: Injuries or accidents that cause a hard blow to the chest may damage the sac.
  • Germs: Germs, such as viruses and bacteria, may cause this condition. Infection in other areas of the body may also spread to the sac.
  • Medicines: Medicines such as those used to treat high blood pressure, cancer, and infection can cause pericarditis.
  • Procedures: Heart surgery or radiation therapy can cause pericarditis.
  • Medical conditions:
    • Heart attack: A heart attack can damage the heart muscle and cause pericarditis.
    • Kidney failure: Fluid and chemicals may build up in your body and around your heart when your kidneys fail.
    • Other conditions: Autoimmune diseases, cancer, or tuberculosis may damage the sac or increase the amount of fluid. If you are pregnant, your growing baby may push on your heart and cause problems.

What are the signs and symptoms of chronic pericarditis?

Your signs and symptoms may have come and gone over a long time. You may have any of the following:

  • Pain in your chest that becomes worse when you lie down
  • Fast heartbeat
  • Shortness of breath
  • Fever
  • Feeling more tired than usual and getting tired easily

How is chronic pericarditis diagnosed?

Your healthcare provider will examine you and ask about past medical problems. He will listen to your heart. You may also have any of the following tests:

  • Blood tests: You may need blood taken to give healthcare providers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  • Telemetry is continuous monitoring of your heart rhythm. Sticky pads placed on your skin connect to an EKG machine that records your heart rhythm.
  • Chest x-ray: This is a picture of your lungs and heart. Healthcare providers use it to see the fluid around your heart. Chest x-rays may show signs of infection in the pericardium.
  • An echocardiogram is a type of ultrasound. Sound waves are used to show the structure and function of your heart.
  • Transesophageal echocardiogram:
    • A transesophageal echocardiogram (TEE) is a type of ultrasound that shows pictures of the size and shape of your heart. It also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen. You may need a TEE if your heart does not show up very well in a regular echocardiogram. You may also need a TEE to check for certain problems such as blood clots or infection inside the heart.
    • You will be given medicine to relax you during a TEE. Healthcare providers put a tube in your mouth that is moved down into your esophagus (food pipe). The tube has a small ultrasound sensor on the end. Since your esophagus is right next to your heart, your healthcare provider can see your heart clearly.
  • CT scan: This is also called a CAT scan. An x-ray machine uses a computer to take pictures of your heart. You may be given dye before the pictures are taken. People who are allergic to iodine or shellfish (crab, lobster, or shrimp) may be allergic to some dyes. Tell your healthcare provider if you are allergic to shellfish, or have other allergies or medical conditions.
  • Magnetic resonance imaging: This test is called an MRI. During the MRI, pictures are taken of your heart. An MRI may be used to show the amount of fluid around your heart. You will need to lie still during this test. The MRI machine contains a powerful magnet. Never enter the MRI room with any metal objects. This can cause serious injury. Tell your healthcare provider if you have any metal implants in your body.
  • Pericardiocentesis: This is a procedure where extra fluid from the sac is drained using a long needle. This fluid is sent to a lab to check for infection.
  • Pericardial biopsy: This is a procedure where a small piece of the heart sac is removed. It is then sent to a lab for tests.

How is chronic pericarditis treated?

  • Medicines:
    • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    • Steroids: This medicine may be given to decrease inflammation.
  • Procedures: You may need any of the following procedures:
    • Balloon pericardiotomy: This uses a small balloon to make a hole in your heart sac to drain the fluid.
    • Pericardiectomy: Your healthcare provider makes a cut into your chest and removes or repairs areas of the sac that are damaged.

What are the risks of chronic pericarditis?

You may have infection or bleeding when the fluid in the sac is removed. Even after treatment, your condition may come back. Without treatment, your heart can scar. Your heart may not beat correctly, and there might not be enough blood and oxygen getting to your body organs. This may damage your organs and be life-threatening.

When should I contact my healthcare provider?

  • You have a fever.
  • Your symptoms do not go away or get worse.
  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You have shortness of breath, which is worse when you lie down.
  • Your chest pain does not go away.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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