Pericarditis: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate pericarditis (inflammation of the heart sac):

The clinical picture ranges from mild decreased performance to severe dyspnea (shortness of breath) as a sign of heart failure (cardiac insufficiency).

Acute pericarditis

Leading symptoms

  • Pericarditic chest pain/acute chest pain (chest pain), i.e., stabbing retrosternal (behind the sternum/chest bone) pain [pain often disappears with wet pericarditis]
    • Retrosternal (“behind the sternum”) or left thoracic (“left chest”) pain
    • May radiate to the neck, nape of the neck, left shoulder, or arms
    • Pain gets better after sitting up and bending forward
    • Intensify when lying down, coughing or deep breathing.
  • Pericardial rubbing sounds (“leather creaking”) in auscultation (when listening to the heart).
  • Fever, is possible (body temperature > 38 °C is considered an indication of a prognostically unfavorable course).

However, in many cases, there are no specific symptoms.

According to the European Society of Cardiology (ESC) guideline, acute pericarditis can be diagnosed when two of the following four criteria are met:

  • Pericarditic chest pain (>85-90%).
  • Pericardial rubbing sounds/pericardial rubbing (“leather creaking”) on auscultation (< 33%)
  • New ST elevations or PR depressions in the ECG that cannot be strictly regionally assigned (about 60%)
  • New or worsening pericardial effusion on echocardiography (approximately 60%).

Inflammatory parameters (CRP, ESR) and imaging (CT, cardio-MRI) can provide additional information but are not mandatory for diagnosis.

Chronic pericarditis

The following symptoms and complaints may indicate chronic pericarditis:

  • Weakness/fatigue
  • Weight gain, especially increase in abdominal girth (abdominal girth gain) (due toascites/abdominal dropsy).
  • Abdominal discomfort (abdominal pain)
  • Edema (water retention) to anasarca (accumulation of edema / tissue fluid in the connective tissue of the subcutis), thus generalized edema / water retention (ie on the complete body).
  • Cachexia (pathological, very severe emaciation).
  • Decrease in skeletal muscle mass
  • Exertional yspnea (shortness of breath on exertion).