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[Conditions](https://durgical.com/en/conditions/) · [Chest](https://durgical.com/en/anatomy/region/chest/)

# Acute pericarditis

Acute pericarditis is inflammation of the [pericardium](https://durgical.com/en/anatomy/pericardium/), the sac around the heart, causing sharp chest pain and sometimes fluid around the heart.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Pericardium](https://durgical.com/en/anatomy/pericardium/)
- [Phrenic nerves](https://durgical.com/en/anatomy/phrenic-nerve/)
- [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/)
- [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/)

## Microorganisms that cause it

- [Enteroviruses](https://durgical.com/en/microbiology/enteroviruses/)

## In the clinical exam

- [Cardiac auscultation: the areas and the order](https://durgical.com/en/clinical-exam/cardiac-auscultation-the-areas-and-the-order/)
- [Cardiac tamponade: Beck triad and pulsus paradoxus](https://durgical.com/en/clinical-exam/cardiac-tamponade-beck-triad-and-pulsus-paradoxus/)
- [Chest pain: ischemic, pericardial, pleural and other patterns](https://durgical.com/en/clinical-exam/chest-pain-ischemic-pericardial-pleural-and-other-patterns/)

## In physiology

- [The ECG in ischemia and infarction](https://durgical.com/en/physiology/the-ecg-in-ischemia-and-infarction/)

## Why it happens

- [Patterns of acute inflammation: serous, fibrinous, purulent, abscess, ulcer](https://durgical.com/en/general-pathology/patterns-of-acute-inflammation-serous-fibrinous-purulent-abscess-ulcer/)
- [The myocardial infarct over time: what the pathologist sees from hours to months](https://durgical.com/en/general-pathology/the-myocardial-infarct-over-time-what-the-pathologist-sees-from-hours-to-months/)
- [Vascular changes in acute inflammation: vasodilation, leakage, exudate vs transudate](https://durgical.com/en/general-pathology/vascular-changes-in-acute-inflammation-vasodilation-leakage-exudate-vs-transudat/)
- [The heart wall, valves and conduction tissue](https://durgical.com/en/histology/the-heart-wall-valves-and-conduction-tissue/)

## What it is

Acute inflammation of the pericardium, the sac around the heart, causing sharp chest pain and sometimes a pericardial effusion.

## Who gets it

A common cause of non-ischaemic chest pain in emergency departments, mostly in young and middle-aged adults. In high-income settings most cases are idiopathic or viral; in Colombia and Latin America tuberculosis must be considered, especially with large effusions or HIV.

## Causes

- Idiopathic or presumed viral (most cases)
- Tuberculosis and other bacterial infections
- After myocardial infarction or cardiac surgery (post-injury syndromes)
- Autoimmune diseases such as lupus and rheumatoid arthritis
- Uraemia, malignancy, chest radiation and some drugs

## Risk factors

- Recent viral illness
- Male sex and young adult age
- Recent heart attack or cardiac surgery
- Autoimmune disease
- [Kidney](https://durgical.com/en/anatomy/kidney/) failure
- Tuberculosis exposure or HIV

## Pathophysiology

Inflammation of the visceral and parietal pericardium causes fibrinous exudate, which produces pain and a friction rub. Inflammation of the adjacent epicardium gives diffuse ST changes. Fluid may accumulate; if it builds quickly, it can compress the heart.

## Classification

- Acute (first episode)
- Incessant (lasting several weeks without remission)
- Recurrent (new episode after a symptom-free interval)
- Chronic (lasting months) and constrictive pericarditis

## Symptoms and signs

- Sharp, pleuritic central chest pain
- Pain better sitting up and leaning forward, worse lying flat
- Pain radiating to the [trapezius](https://durgical.com/en/anatomy/trapezius-muscle/) ridge (phrenic innervation)
- Pericardial friction rub, scratchy and best heard at the left sternal border
- Fever and recent flu-like illness

## Red flags

- Hypotension, raised jugular pressure or pulsus paradoxus (tamponade)
- Large effusion on echocardiography
- High fever or suspected bacterial cause
- Raised troponin with reduced heart function (myopericarditis)
- Immunosuppression or failure to respond to anti-inflammatory drugs

## Diagnosis

**Clinical**
Usually requires two of four features: typical [chest](https://durgical.com/en/anatomy/region/chest/) pain, friction rub, compatible ECG changes and a new or worsening pericardial effusion. Raised inflammatory markers support it.

**Tests**
ECG: diffuse concave ST elevation with PR depression (PR elevation in aVR), evolving over days. Troponin to detect myocardial involvement; CRP, blood count, renal function; further tests by suspected cause.

**Imaging**
Echocardiography for effusion and ventricular function. Chest X-ray is often normal; cardiac MRI shows pericardial inflammation in unclear cases.

## Differential diagnosis

- Acute myocardial infarction
- Pulmonary embolism
- Aortic dissection
- Pneumonia with pleurisy
- Myocarditis
- Pneumothorax

## Goal of treatment

Relieve pain and inflammation, treat the underlying cause and prevent recurrence and tamponade.

## Treatment

**Medical**
Non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin, tapered as symptoms and inflammatory markers settle.

**Medical**
Colchicine added to reduce symptoms and lower the risk of recurrence.

**Medical**
Corticosteroids reserved for specific causes, contraindications or refractory cases; cause-specific treatment such as antituberculous therapy.

**Conservative**
Rest from strenuous exercise until symptoms and markers resolve (longer in athletes and with myocarditis).

**Follow-up**
Follow-up with CRP and echocardiography; admission for high-risk features.

## Complications

- Recurrent pericarditis
- Pericardial effusion and cardiac tamponade
- Constrictive pericarditis
- Myopericarditis

## Prognosis

Idiopathic or viral pericarditis usually settles within weeks with good outcome. Recurrence is common without colchicine. Tuberculous, bacterial and malignant causes carry higher risks of tamponade and constriction.

## Test yourself

Think of the answer, then tap the question to see it.

## Which posture typically relieves the pain of acute pericarditis?

Sitting up and leaning forward; lying flat makes it worse.

## What is the classic ECG finding in acute pericarditis?

Diffuse concave ST elevation with PR depression, not limited to one coronary territory, and PR elevation in aVR.

## Which drug classes are first-line for idiopathic acute pericarditis?

NSAIDs or aspirin combined with colchicine, which also lowers the risk of recurrence.

## Why can pericarditis pain radiate to the trapezius ridge?

The parietal pericardium is supplied by the phrenic nerves (C3–C5), which share segments with the shoulder region.

## Which infectious cause should be considered in Latin America for pericarditis with a large effusion?

Tuberculosis, especially in people with HIV.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/acute-pericarditis/)

## Related conditions

- [Cardiac tamponade](https://durgical.com/en/conditions/cardiac-tamponade/)
- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Pulmonary tuberculosis](https://durgical.com/en/conditions/pulmonary-tuberculosis/)
- [Systemic lupus erythematosus](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)
- [Aortic dissection](https://durgical.com/en/conditions/aortic-dissection/)
- [Pneumothorax](https://durgical.com/en/conditions/pneumothorax/)
- [Costochondritis](https://durgical.com/en/conditions/costochondritis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Pericarditis](https://www.ncbi.nlm.nih.gov/books/NBK431080/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/conditions/acute-pericarditis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/acute-pericarditis/