Pericarditis risk factors: who is more likely

What pericarditis is

The pericardium is a sac made of two thin layers of tissue with a small amount of fluid between them. It holds the heart in place in the chest and protects it from infection. Pericarditis is inflammation of this sac. Depending on how long it lasts, a provider may call it acute, subacute, chronic or recurrent (NHLBI).

Some people with pericarditis also get a buildup of fluid in the sac, called a pericardial effusion. If too much fluid builds up, the heart may not be able to pump normally. This is called cardiac tamponade, and it can be life-threatening (NHLBI).

Pericarditis is one of three types of heart inflammation. The other two are myocarditis (the heart muscle) and endocarditis (the lining of the heart and its valves) (NHLBI). See endocarditis risk factors for that infection, which has a different set of risks.

What causes it

MedlinePlus says pericarditis can come from a virus or other infection, a heart attack, heart surgery, other medical conditions, injuries and certain medicines (MedlinePlus). NHLBI adds detail on the main groups (NHLBI):

• Viruses are the most common cause of pericarditis and myocarditis. Examples NHLBI names are SARS-CoV-2 (the virus that causes COVID-19), adenovirus, coxsackievirus (including hand, foot, and mouth disease), herpes virus, influenza and parvovirus B19.
• Fungi such as yeast or mold are rare causes. These infections are more common in people whose immune systems are weak from conditions such as HIV/AIDS, cancer or diabetes.
• Autoimmune diseases such as rheumatoid arthritis and lupus may cause pericarditis.
• Medicines. Side effects of some medicines may lead to pericarditis, myocarditis or both. NHLBI lists antibiotics, antidepressants, benzodiazepines (tranquilizers), diuretics, heart medicines, psychiatric medicines, seizure medicines and weight-loss medicines.

Who is more likely to get it

NHLBI lists these risk factors for heart inflammation (NHLBI):

• Age. Pericarditis can affect all ages, but it occurs more often in young adults, and it also affects middle-aged adults.
• Sex. Pericarditis occurs twice as often in men as in women. The exception is inflammation caused by autoimmune diseases such as lupus and rheumatoid arthritis, which are more common in women.
• Genes and family history. Your genes may play a role in how your body responds to infection and inflammation and whether you get pericarditis. Rare inherited conditions that affect how the body controls inflammation, such as familial Mediterranean fever and tumor necrosis factor receptor-associated periodic syndrome (TRAPS), can raise the risk.
• Lifestyle. Drinking too much alcohol, and using cocaine, amphetamines or recreational drugs injected into the veins.
• Medical conditions: diabetes, which can make infections more likely; eating disorders such as anorexia; HIV/AIDS; skin disorders such as burns or chronic infections; and poor dental health.
• Procedures to treat other conditions, such as implanting a pacemaker or defibrillator, carry a risk of infection that can lead to heart inflammation.

NHLBI lists these for heart inflammation as a whole (pericarditis, myocarditis and endocarditis), not for pericarditis alone, and gives no score (NHLBI).

Symptoms

NHLBI lists these pericarditis symptoms (NHLBI):

• Chest pain that feels sharp, gets worse with breathing, and feels better when you sit up and lean forward
• A fast heartbeat
• Shortness of breath
• Pain in the neck or shoulders that can be mild or severe
• Fever

If a virus causes heart inflammation, you may have a cough, runny nose or stomach and bowel symptoms a few weeks before other symptoms. Some symptoms may feel like the flu and go away on their own after a few weeks (NHLBI). MedlinePlus says fever is a common symptom of acute pericarditis (MedlinePlus).

Can it come back?

Yes. NHLBI says people with pericarditis can develop it again in the first 18 months after treatment, and treatment often lasts weeks. Blood tests for markers of inflammation may be repeated until the levels return to normal (NHLBI).

Can you prevent it?

NHLBI says you may not be able to prevent heart inflammation, and many causes of pericarditis and myocarditis are hard or impossible to avoid or prevent (NHLBI). Talk with your provider about any risk factors you have, such as an autoimmune disease or a medicine you take.

Common questions

What is the most common cause of pericarditis?

NHLBI says viruses are the most common cause of pericarditis and myocarditis (NHLBI).

Who gets pericarditis most often?

It occurs more often in young adults and also affects middle-aged adults, and it occurs twice as often in men as in women (NHLBI).

Is pericarditis the same as a heart attack?

No, but the symptoms can feel like a heart attack, so NHLBI says to call 911 or seek help right away for chest pain or severe shortness of breath (NHLBI). MedlinePlus lists a heart attack as one possible cause of pericarditis (MedlinePlus).