Pericarditis is inflammation of the tissue around the heart, or pericardium. The pericardium holds the heart in place and helps it function. People with chronic pericarditis require ongoing rest and care.

The pericardium is a sac consisting of two layers of tissue separated by fluid, which helps reduce friction. During pericarditis, these layers experience inflammation, which can cause them to rub against each other or the heart.

This article explores the types of chronic pericarditis and their symptoms and treatments. It also discusses when to contact a doctor and tips for maintaining good heart health.

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There are several types of longer-lasting or complicated pericarditis.

Chronic vs. recurrent pericarditis

According to a 2021 literature reviewTrusted Source, clinicians define pericarditis as chronic if symptoms continue for more than 3 months.

In contrast, recurrent pericarditis is characterized by flare-up of symptoms 4 to 6 weeks after a symptom-free period. Up to 30% of people with a first episode of acute pericarditis can experience recurrent pericarditis.

Pericardial effusion

Also known as cardiac tamponade, pericardial effusion involves a buildup of fluidTrusted Source in the pericardial sac. This can affect the movement of blood through the chambers of the heart, causing a rapid drop in blood pressureTrusted Source. If the sac fills up too much, it can impair the heart from filling and pumping blood, leading to a medical emergency.

Chronic constrictive pericarditis

People with this type of pericarditis experience scarring on the pericardium. This causes it to become thicker and less elastic, reducing its efficiency. Chronic constrictive pericarditis develops slowly over time.

In rare cases, people may develop constrictive-effusive pericarditis. This type can cause both thickening and fillingTrusted Source of the heart sac. It is typically a chronic condition that requires surgical treatment.

Symptoms of chronic pericarditisTrusted Source may differ from those of acute flares of pericarditis.

Other symptoms might include:

  • fatigue, or extreme tiredness
  • breathlessness
  • coughing

People with severe chronic pericarditis may experience edema, or swelling in the legs, ankles, feet, and belly. Low blood pressure might also occur.

Pericarditis can last for only a short while. However, people can experience recurrent pericarditis flares for months or even years.

Treatment for recurrent (chronic) pericarditis can take many years. People with the condition may receive around 4.7 to 6.2 years of treatment with anti-inflammatory medications, according to a 2023 analysis. During this time, careful management and lifestyle adjustments may be necessary to prevent complications.

Treatment for chronic pericarditis often involves surgery to treat constriction or effusion.

Treatment for acute pericarditis aims to use medications to relieve pain and inflammation, and to address the underlying infection. This often involves:

  • colchicine, an anti-inflammatory medication
  • anti-inflammatories such as aspirin and ibuprofen
  • prednisone, a steroid for pericarditis not responsive to traditional anti-inflammatory treatment
  • If the symptoms of acute pericarditis return (recurrent pericarditis), then IL-1 inhibitors could be used to treat the RP and reduce the risk of future recurrences.

ARCALYST (rilonacept) is the only FDA-approved therapy for the treatment of recurrent pericarditis and reduction in risk of recurrence in adults and pediatric patients 12 years and older

Pericardiocentesis

This surgical procedure helps to treat pericardial effusion. During the procedure, a doctor inserts a tube or needle into the wall of the chest. They then drain excess fluid from the pericardium. They may also carry out other procedures to remove fluid from around the heart. This helps to relieve pressure on the heart and restore normal function.

Pericardiectomy

This is the only cure for chronic constrictive pericarditis. It is usually a last resort when symptoms become severe. In a pericardiectomy, a surgeon removes the pericardium.

Guidance from professional societies, such as the European Society of Cardiology guidelines for pericarditis, recommend some lifestyle changes for people recovering from pericarditis

People recovering from pericarditis should limit physical activity for some time. The timing depends on whether or not the heart muscle was inflamed or not, and a cardiologist can provide specific guidance.

It is also important for people with chronic pericarditis to monitor their heart health in general. A slow return to exercise after recovery can help people protect their heart.

It is important to incorporate lifestyle changes to keep your heart healthy, which can includeTrusted Source:

  • choosing a diet high in fiber and low in:
    • salt
    • sugar
    • saturated and trans fats
    • cholesterol
    • alcohol
  • maintaining a healthy body weight within a normal body mass index (BMI) range
  • avoiding or quitting smoking
  • regularly checking cholesterol levels, blood sugar, and blood pressure to monitor metabolic health

People should speak with a doctor about any medications or treatments that may be necessary to manage general heart health following a chronic pericarditis diagnosis.

Anyone experiencing chest pain or concerning symptoms such as shortness of breath requires emergency medical attention as it may be a heart attack.

Unlike acute pericarditis, people with chronic pericarditis do not always experience chest pain. However, if they do, the pain may sit in the center or left of the chest. It may feel better when a person sits up or leans forward.

Pericarditis pain may also feel like:

  • stabbing
  • sharpness
  • aching
  • pressure

People experiencing any of these symptoms should seek medical attention. People experiencing the following symptoms should also contact emergency services:

  • pain that spreads to the back, neck, jaw, or arms
  • tightness or heaviness in the chest
  • breathlessness
  • sweating
  • nausea
  • pain lasting longer than 15 minutes

Chronic pericarditis refers to inflammation of the outer layer of the heart that lasts for longer than 3 months. It occurs when scarring causes this layer to thicken, or the sac fills with fluid.

Surgery is usually necessary to treat chronic pericarditis. After surgery, it is important for people to rest and avoid exertion until symptoms improve and diagnostic tests show normal results.

People experiencing chest pain should contact their doctor.