Pericarditis

Chest pain that is worse lying down and better sitting forward. Usually not a heart attack, and it still needs an ECG.

What it is

Inflammation of the sac around the heart. Most cases follow a viral infection, and many have no identified cause at all.

The pain has a characteristic pattern that distinguishes it from a heart attack: sharp rather than crushing, worse on lying flat and on breathing in, and relieved by sitting up and leaning forward. That does not mean it can be diagnosed at home. Chest pain needs an ECG and a clinical assessment, every time.

Most people recover fully within a few weeks with anti-inflammatory treatment. Colchicine added to that halves the recurrence rate and is frequently not prescribed.

Two complications matter. A large pericardial effusion can compress the heart, called tamponade, which is a life-threatening emergency. And around one in three people get a recurrence, sometimes several, which is exhausting and demoralising and needs specialist management rather than repeated short courses.

It can also occur after a heart attack, after cardiac surgery, with rheumatoid arthritis or lupus, with kidney failure, and rarely with tuberculosis or cancer.

Signs you might notice

Sharp chest pain behind the breastbone, often spreading to the neck, shoulder or left arm.

Worse lying flat, worse on deep breathing or coughing, better sitting up and leaning forward.

Fever, and often a preceding viral illness.

Breathlessness, palpitations, fatigue.

999: chest pain that is crushing or heavy, pain with sweating or nausea, severe breathlessness, or collapse. Assume a heart attack until proven otherwise.

Urgent: increasing breathlessness, swelling of the neck veins, light-headedness or a falling blood pressure, which can indicate tamponade.

How it can affect day-to-day life

The pain is frightening because it is chest pain, and the reassurance that it is not the heart muscle rarely lands the first time.

Recurrence is the main long-term burden. People go through repeated courses of treatment, repeated fear, and repeated time off, and it is worth pushing for a cardiology opinion rather than cycling through the same short prescriptions.

Exercise restriction is usually advised until symptoms and inflammatory markers settle, and is often not explained clearly, leaving people either frightened to move or exercising too soon.

Anti-inflammatory treatment is used at higher doses and for longer than people expect, and stomach protection matters alongside it. See peptic ulcer.

Supporting someone well

Treat any new chest pain as needing assessment. Do not diagnose pericarditis at home.

Ask about colchicine alongside the anti-inflammatory. It substantially reduces recurrence and is under-prescribed.

Take the anti-inflammatory course to completion rather than stopping when the pain eases, and ask about stomach protection.

Ask what activity is allowed and when to build back up.

Report increasing breathlessness or light-headedness urgently.

For a second or third episode, ask for a cardiology referral and for investigation of an underlying cause.

Where to get help

999 for chest pain that could be a heart attack.

A GP practice or urgent care for assessment; an ECG is the minimum.

Cardiology for recurrent pericarditis.

British Heart Foundation on 0808 802 1234.