A sharp pain in the chest, towards the center or slightly to the left, with shortness of breath would immediately raise the concern about a heart attack. While these symptoms are typical of heart attacks, it can also occur with other less serious heart conditions. Pericarditis is one such condition. It can become serious over time if severe and not treated properly. However, unlike with a heart attack, pericarditis will not lead to death within minutes of arising.
What Happens in Pericarditis?
The heart has a lining around it which forms a sac. Small amounts of fluid in the sac provides lubrication as the heart contracts and relaxes within the chest cavity. This lining is known as the pericardium and is composed of two layers between which the pericardial fluid exists. Pericarditis is inflammation of the pericardium. It can be acute where it arises suddenly and can be severe or chronic where it arises gradually and exists for a long period of time.
Read more on pericarditis.
The exact cause of pericarditis is not always clearly evident. It appears that viral infection of the pericardium is among the more common cause of acute pericarditis. However, there are a host of other non-infectious causes. Pericarditis should be considered as cause of the symptoms below a short while after a heart attack or heart surgery. This is known as Dressler syndrome. Autoimmune conditions, chest injury, certain medication and life threatening condtions like cancer may also be responsible for pericarditis.
Inflammation of the pericardium can also involve the middle muscular layer of the heart (myocardium). This is a more serious condition with possibly life-threatening complications. Inflammation of the pericardium also results in increased fluid in the pericardial sac. Sometimes this fluid accumulation can be severe and affect the dilation of the heart during the relaxation phase. This is known as a cardiac tamponade and affect circulaton. It may even be fatal.
How To Spot Pericarditis
Pericarditis can sometimes occur with a few mild symptoms that some patients ignore or may not immediately associate with a cardiac condition. Often the symptoms of pericarditis are mistaken for a heart attack which is a more widely known condition and a heart attack should only be ruled out after a professional medical assessment. In fact, the signs and symptoms mentioned below should be considered to be a medical emergency until proven otherwise.
Sharp Pain in the Chest
Pericarditis typically presents with a sharp chest pain. This is in contrast to a heart attack where the pain is described as being constricting or suffocating in nature. However, heart attack symptoms can be atypical at times and heart attack pain may be be sharp in nature like pericarditis pain. Similarly the pain in pericarditis may not always be sharp but could also be experienced as an ache,, burning pain or pressing pain which may somewhat resemble heart attack pain.
Understandably pericarditis pain is also located in the central chest (pain behind the sternum) and sometimes slightly to the left side. Usually the cardiac pain in pericarditis is referred to the jaw or arm on the left side as occurs with a heart attack. The pain in pericarditis may be very mild to severe in intensity. It tends to worsen when lying flat or breathing in deeply and eases somewhat by leaning forward when in the sitting position. These changes in chest pain does not usually occur during a heart attack.
Read more on cardiac vs non-cardiac chest pain.
Low Grade Fever
A low grade fever is also present in many cases of pericarditis. This may be due to an infection, as most of the time acute pericarditis is due to an infection. However, it can also occur without any infection, especially where pericarditis may be associated with autoimmune conditions lupus (SLE). Tuberculous pericarditis (due to TB) should be suspected when pericarditis is accompanied by fever, night sweats and unintentional weight loss.
Shortness of Breath
Shortness of breath is another common symptom of pericarditis. It is usually mild and may also be accompanie by rapid breathing. Most of the time this shortness of breath worsens when lying flat and eases to some degree when upright. However, when the inflammation extends to the heart wall or if there is extensive fluid accumulation around the heart which affects heart activity, thn the shortness of breath can be severe.
Palpitations are present in most cases of pericarditis. It is one of the main reasons why people with pericarditis seek medical attention. However, as with chest pain and other symptoms mentioned above, it is not unique to pericarditis. Patients may describe it as a fluttering of the heart, pounding of the heart or some other unusual sensation (apart from pain) arising from the central chest.
A cough is another feature of pericarditis. It is present both in acute and chronic pericarditis to varying degrees and is often worse in acute pericarditis. The cough is usually mild in nature and typically dry (non-productive). Coughing usually causes momentary worsening of the chest pain.
Another symptom that may also be present with pericarditis is difficulty swallowing (dysphagia). It is not always present. The swallowing may worsen the chest pain momentarily. The difficulty swallowing may be felt like food being stuck in the chest after swallowing a bite of food.
Malaise and Tiredness
Malaise, or the feeling of being unwell, is another common symptom in pericarditis. It may be worse in severe cases where heart activity is affected and oxygenation of the blood is impaired even slightly. Tiredness or fatigue also tends to be worse in these more severe cases of pericarditis.
Abdominal and Leg Swelling
Swelling in the feet and lower leg may also occur with pericarditis. This usually indicates some degree of heart activity impairment. Abdominal swelling may also occur. Children may also experience abdominal pain with or without abdominal swelling.
Other Signs and Symptoms
- Loss of consciousness (sometimes)
- Low blood pressure (hypotension)
- Rapid heart rate (tachycardia)
- Bluish discoloration of the skin (cyanosis)
- Enlarged liver (hepatomegaly)