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Pericarditis (Inflammation Around the Heart)

Pericarditis is inflammation of the thin sac around the heart. It causes sharp chest pain that is often worse when you lie flat or take a deep breath and better when you lean forward. Most cases settle with treatment, but because the pain can feel like a heart attack, new chest pain always needs to be checked — and some people have repeat episodes.

Chest pain can be a heart attack — call 911. Pericarditis pain can feel like a heart attack, so if you have chest pain or severe shortness of breath, or your symptoms get worse, call 911 or get medical help right away (NHLBI). NHS guidance lists these heart attack warning signs: sudden chest pain that spreads to the arms, back, neck or jaw, makes the chest feel tight or heavy, started with shortness of breath, sweating or feeling sick, or lasts more than 15 minutes. Don’t drive yourself to the hospital (NHS).

Signs that fluid may be squeezing the heart (cardiac tamponade) — call 911. Cardiac tamponade, when fluid, blood or pus collects in the sac and presses on the heart, is a medical emergency (Adler et al., 2023). The most common symptom is shortness of breath (Alerhand et al., 2022); weakness, tiredness, a fast heartbeat, passing very little urine and low blood pressure can also occur (Adler et al., 2023). Don’t wait for low blood pressure to act: in one emergency-room study of 34 people with tamponade, only 5 had low blood pressure when they arrived (Kapoor et al., 2012).

Call your doctor promptly for sharp or stabbing chest pain that gets worse when you take a deep breath in, swallow, cough or lie down; NHS advice is to ask for an urgent appointment (NHS). If you already have pericarditis, also tell your provider about a fever or chills, or symptoms of heart failure such as shortness of breath, tiredness or swelling in your legs (NHLBI).

Never wait for a chiropractic, acupuncture or massage appointment — or try an herb — for any of these signs.

What is pericarditis?

The pericardium is a sac around the heart made of two thin layers of tissue with a little fluid between them. The fluid keeps the layers from rubbing together; the sac holds the heart in position and protects it from infection. Pericarditis means this sac is inflamed (NHLBI). The NHS says it is not usually serious but can sometimes cause serious health problems (NHS).

  • Acute pericarditis comes on suddenly. Subacute means it appears within weeks or a few months of the event that caused it, chronic means it lasts a long time, and recurrent means it comes back (NHLBI). One review defines “recurrent” as a relapse after at least 4 to 6 symptom-free weeks, “incessant” as an earlier relapse or symptoms that last beyond 4 to 6 weeks, and “chronic” as lasting more than 3 months (Andreis et al., 2021).
  • Pericardial effusion is a buildup of fluid in the sac. If too much fluid collects the heart may not pump normally — this is cardiac tamponade, which can be life-threatening (NHLBI). See Fluid around the heart below.
  • Constrictive pericarditis is a rare, longer-term problem in which the sac itself limits how well the heart can fill (Goldstein, 2004). See Constrictive pericarditis and surgery below.

Pericarditis accounts for up to 5% of emergency-room visits for chest pain that isn’t caused by blocked heart arteries. With treatment, 70% to 85% of people have a benign course (Cremer et al., 2024). It can affect all ages but is more common in young and middle-aged adults, and occurs about twice as often in men as in women (NHLBI).

What causes it?

The sac can become inflamed from a virus or other infection, a heart attack, heart surgery, other medical conditions, injuries and certain medicines (MedlinePlus). In North America and Western Europe the most common causes are “idiopathic” (no cause found) or viral, followed by pericarditis after cardiac procedures or operations (Cremer et al., 2024). Doctors often don’t confirm the exact cause; the NHS says it is usually a viral infection such as a cold or flu (NHS).

Symptoms

The main symptom is chest pain that feels sharp or stabbing, may spread to the shoulders, arms or tummy, and gets worse when you breathe in deeply, swallow, cough or lie down — especially on your left side — and better when you lean forward. You may also have a high temperature, a cough or painful joints (NHS). NHLBI adds a fast heartbeat, shortness of breath and neck or shoulder pain that can be mild or severe (NHLBI). In one review, sharp chest pain that is worse lying flat was present in about 90% of people with acute pericarditis (Cremer et al., 2024).

How it’s diagnosed

A provider listens to your heart for a grating sound called a pericardial friction rub, which comes from the inflamed layers rubbing together, and may order an ECG of the heart’s electrical rhythm, an echocardiogram (sound-wave pictures of the heart), a chest X-ray and blood tests such as C-reactive protein (CRP), which is higher when there is inflammation (NHLBI, NHLBI, NHS).

One review says acute pericarditis is diagnosed when at least 2 of 4 features are present: the typical pain; new widespread changes on the ECG (about 25% to 50% of people); a new or increased fluid collection around the heart, usually small (about 60%); and a friction rub (fewer than 30%) (Cremer et al., 2024). In doubtful or recurrent cases, cardiac MRI or CT can show whether the sac is inflamed or thickened (Andreis et al., 2021). Your provider may run more tests to look for a cause (NHLBI).

When to see a doctor: get new chest pain checked right away, and call 911 for the warning signs above. If you’ve been diagnosed, keep your follow-up visits and continue your medicines as directed (NHLBI). For related topics, see our heart disease, circulation, fainting and blood pressure guides.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Diagnosis with an ECG, echocardiogram and blood tests; anti-inflammatory medicines (NSAIDs or aspirin) plus colchicine as the usual first step; steroids if those don’t work; rilonacept (FDA-approved for recurrent pericarditis) or other IL-1 blockers for repeat episodes; draining fluid for tamponade; surgery in rare constrictive cases. Cost estimate being researched. Most people feel better within a few weeks, but 15% to 30% have a recurrence. Each medicine has real warnings (stomach bleeding, heart and stroke risk with NSAIDs; blood-count and interaction risks with colchicine; infection risk with rilonacept).
Chiropractic No role in treating pericarditis. Neck and shoulder pain can be part of pericarditis, so it should be checked by a medical doctor first. Typical follow-up about $55–$100; first visit about $90–$200 (The Pricer). We found little research on chiropractic care for pericarditis. A 2021 review found no clear benefit of spinal manipulation for conditions outside the muscles and joints.
Acupuncture No proven role in treating pericarditis. Sometimes sought for comfort or stress. Private follow-ups about $90–$185; community clinics about $50–$90 (The Pricer). We found little research on acupuncture for pericarditis, and a few rare case reports of heart-sac complications after acupuncture. Not a substitute for medical care.
Herbal medicine No herb or supplement is proven to treat pericarditis. The main issue is safety: interactions with colchicine, NSAIDs and steroids. Cost estimate being researched. Colchicine labels say to avoid grapefruit and grapefruit juice and to report every herbal product. Show every supplement to your doctor or pharmacist.
Massage therapy Gentle massage for relaxation only, once a medical doctor has evaluated your chest pain and any acute episode has settled. At one national chain, about $125–$160 for 60 minutes for non-members (The Pricer). We found little research on massage for pericarditis. Risk of harm is low overall, but never massage over a painful chest or to treat chest pain.
MBHA Wellness Coach Help sticking with the medicine and follow-up plan, tracking symptoms, pacing activity as your doctor directs, and building sleep and stress habits. Cost estimate being researched. Supports — never replaces — medical care. Especially useful for the long taper schedules and follow-up visits that recurrent pericarditis can involve.

Approach 1 of 6

Conventional medicine (AMA)

Treatment depends on what is causing the pericarditis (NHS). Most people feel better within a few weeks (NHS). Your doctor chooses the medicines, strengths and schedule; we don’t list doses.

1. NSAIDs (or aspirin) plus colchicine — the usual first step

One review calls aspirin or a nonsteroidal anti-inflammatory drug (NSAID) together with colchicine the first-step approach (Andreis et al., 2021). For a first episode with no special cause, or after a heart procedure or operation, NSAIDs are given and then tapered over several weeks once the chest pain is gone and the CRP blood test has returned to normal; a 3-month course of colchicine is added to relieve symptoms and lower the chance of recurrence (Cremer et al., 2024). Sitting up or leaning forward can also ease the pain (NHS).

NSAID warnings. MedlinePlus warns that NSAIDs such as ibuprofen may raise the risk of a heart attack or stroke, that this can happen without warning, and that the risk may be higher with long-term use or higher doses. It says not to take an NSAID if you recently had a heart attack unless your doctor tells you to. NSAIDs can also cause ulcers, bleeding or holes in the esophagus, stomach or intestine without warning symptoms; the risk is higher with long use, older age, poor health, smoking and heavy drinking. Tell your doctor if you take blood thinners, aspirin, other NSAIDs, oral steroids or certain antidepressants (MedlinePlus).

What the evidence shows for colchicine. In the ICAP trial of 240 adults with a first episode, colchicine added to aspirin or ibuprofen cut incessant or recurrent pericarditis from 37.5% to 16.7%, with similar overall side effects and no serious adverse events (Imazio et al., 2013). In the CORP trial of 120 people with a first recurrence, recurrence at 18 months was 24% with colchicine versus 55% with placebo (Imazio et al., 2011), and in CORP-2, which enrolled 240 people with multiple recurrences, it was 21.6% versus 42.5% (Imazio et al., 2014). For a first recurrence, colchicine is continued for at least 6 months (Cremer et al., 2024).

What the label says. The FDA-reviewed label for colchicine tablets lists gout flares and familial Mediterranean fever, not pericarditis (DailyMed); a separate colchicine tablet is labeled to reduce the risk of heart attack, stroke and related events in adults with atherosclerotic disease or multiple heart risk factors (DailyMed). So colchicine’s use for pericarditis rests on clinical trials and guidelines rather than on a label listing.

Colchicine warnings. The label reports fatal overdoses in adults and children (keep it away from children), blood-count problems, and life-threatening interactions with certain drugs; it tells patients to avoid grapefruit and grapefruit juice, to check with their provider before starting any new medicine (particularly antibiotics), and to report muscle pain or weakness, or numbness or tingling in the fingers or toes (DailyMed). Stomach side effects, mostly diarrhea, affect roughly 8% to 10% of people (Andreis et al., 2021).

2. Steroids — a second line, used carefully

The NHS says a doctor may prescribe steroids if colchicine does not work (NHS); they are often used when pericarditis doesn’t improve with NSAIDs and colchicine (Cremer et al., 2024). A review links steroids to more recurrences, with a dose-dependent effect, so lower doses are preferred; they are still used first in specific situations such as kidney failure, pregnancy, blood-thinner use, an autoimmune disease already treated with steroids, or when aspirin and NSAIDs can’t be taken. That review lists calcium and vitamin D supplements alongside steroid treatment (Andreis et al., 2021). MedlinePlus lists prednisone side effects such as trouble sleeping, mood changes and slowed healing, and says not to stop it suddenly (MedlinePlus).

3. Treating the underlying cause

If bacteria are responsible, antibiotics are used (NHS). TB-related pericarditis is treated with anti-TB therapy, with steroids considered when the sac has become constricted (Cremer et al., 2024). Autoimmune and other causes are treated along with the pericarditis (Andreis et al., 2021).

4. Rilonacept and other IL-1 blockers for repeat episodes

For people with multiple recurrences, interleukin-1 (IL-1) blockers may be preferred to steroids (Cremer et al., 2024). Approval: on March 18, 2021 the FDA approved Arcalyst (rilonacept) injection to treat recurrent pericarditis and reduce the risk of recurrence in adults and children 12 years and older (FDA); the current label still lists this use (DailyMed). Evidence: in the 86-person trial behind the approval, everyone first received rilonacept for 12 weeks; among those then randomized, 23 of 31 people given placebo (74%) had a recurrence versus 2 of 30 (7%) who stayed on rilonacept, both of whom had temporarily stopped it (FDA, Klein et al., 2021). A 2025 analysis of six trials found IL-1 blockers reduced recurrence more than colchicine, with more non-serious side effects; evidence on serious side effects was inconclusive (Ehsan et al., 2025).

Rilonacept warnings: the FDA says serious, life-threatening infections have been reported; people with active or chronic infections should not take it, and live vaccines should be avoided (FDA). The label adds that its effect on cancer risk is not known, that cholesterol and lipid levels can rise, and that recommended vaccinations should be brought up to date before starting; the most common problems in the trial were injection-site reactions and upper respiratory infections (DailyMed, Klein et al., 2021). Anakinra, another IL-1 blocker, was tested in a small trial of 21 people whose pericarditis kept returning despite colchicine and steroids: 2 of 11 on anakinra had a recurrence versus 9 of 10 on placebo, and the authors said larger studies are needed (Brucato et al., 2016).

5. Procedures

Draining fluid from the sac (pericardiocentesis) is used for tamponade, and surgery is sometimes needed for constrictive pericarditis — see the sections below.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

We found little research on chiropractic care for pericarditis, and it has no role in treating the inflammation. A comprehensive 2021 review found only 6 good-quality studies of spinal manipulation for conditions outside the muscles and joints, and none showed a clear benefit (NCCIH).

Why the order matters. Pericarditis can cause neck or shoulder pain (NHLBI), and pain that spreads to the shoulders, arms or tummy (NHS). That can look like a muscle or joint problem. Because pericarditis pain can feel like a heart attack (NHLBI), have new chest, neck or shoulder pain checked by a medical doctor first.

Safety: neck manipulation has been linked to rare tears in the neck arteries that can lead to stroke, though experts disagree about whether manipulation causes them; NCCIH advises sharing your health conditions and medicines with the practitioner (NCCIH).

MBHA caution: MBHA suggests not using chiropractic care for new or unexplained chest, neck or shoulder pain until a medical doctor has found the cause, waiting until an acute episode has settled, and telling your chiropractor about pericarditis and any colchicine, steroid or rilonacept you take.

What it costs

Published cash prices show typical follow-up visits of about $55 to $100 and first visits of about $90 to $200; a course of care can reach $500 to $1,000 (The Pricer).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

We found little research on acupuncture for pericarditis, and none showing it treats the inflammation. Some people try it for comfort or stress; it should never replace medical care for chest pain.

Safety: NCCIH says relatively few complications from acupuncture have been reported, but complications have come from nonsterile needles and improper delivery, and can include infections and punctured organs; the FDA requires acupuncture needles to be sterile and single-use (NCCIH). Rare case reports involve the heart sac itself: a literature review found cardiac tamponade to be the most common acupuncture-related cardiac complication (Ullah et al., 2019); one patient had refractory pericarditis from a needle that had to be removed from the right ventricle (Bedrouni et al., 2021); and an autopsy report described purulent pericarditis from a bloodstream infection that began with a skin infection linked to acupuncture (Yamaguchi et al., 2023). These are case reports, so they can’t tell us how often such problems happen.

MBHA caution: if you try acupuncture, MBHA suggests choosing a licensed practitioner who uses sterile single-use needles, telling them about pericarditis and any steroids, rilonacept or other medicines that weaken the immune system, and asking them to avoid needling over the chest.

What it costs

Private cash prices run about $90 to $185 for follow-ups and $125 to $230 for a first visit; community clinics post about $50 to $90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found little research on herbs or supplements for pericarditis, and none showing that one treats the inflammation. The main question is safety, because pericarditis medicines have real interactions.

Interactions to know about

  • Grapefruit and colchicine: the colchicine label says grapefruit and grapefruit juice may interact and should not be consumed during treatment, and that patients should report any herbal products they use (DailyMed).
  • NSAIDs: MedlinePlus asks you to tell your doctor and pharmacist about all prescription and nonprescription medicines, vitamins, nutritional supplements and herbal products (MedlinePlus). NSAIDs can already cause stomach bleeding, and NCCIH says ginkgo may increase bleeding risk in people taking anticoagulants such as warfarin (NCCIH). MBHA caution: MBHA suggests asking your pharmacist before adding ginkgo or any other product that may affect bleeding while you take an NSAID or aspirin.
  • Supplements in general: NCCIH notes that dietary supplements may interact with your medicines or pose risks if you have certain medical problems (NCCIH). Some supplements your doctor does suggest — such as calcium and vitamin D during steroid treatment (Andreis et al., 2021) — are worth taking as directed.

Never stop or skip colchicine, an NSAID or a steroid to try a supplement. NHLBI says to continue all medicines as directed by your healthcare provider (NHLBI). Show every product to your doctor or pharmacist. We don’t list doses.

What it costs

Cost estimate being researched.

Approach 5 of 6

Massage therapy

We found little research on massage for pericarditis, and it does not treat the inflammation. Gentle massage can be relaxing, and NCCIH says the risk of harm from massage appears low, though rare serious problems such as a blood clot, nerve injury or bone fracture have been reported, some involving vigorous deep-tissue massage or patients at higher risk of injury, such as older adults (NCCIH).

MBHA caution: MBHA suggests booking massage only after a medical doctor has evaluated your chest pain; waiting until an acute episode has settled; choosing a gentle style and asking the therapist to avoid pressure over the chest; and telling the therapist about any blood thinner or other medicine you take. Stop and call your doctor if massage brings on sharp chest pain, shortness of breath or fever. If your pain is new, get care first.

What it costs

Prices vary by location. At one national chain, franchise price lists show about $125 to $160 for a 60-minute massage for non-members and about $65 to $90 for members, whose memberships run about $70 to $90 a month (The Pricer). Tips are extra.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach doesn’t diagnose or treat pericarditis. The coach helps with the everyday side of a medical plan — alongside, never instead of, your doctor.

Keep up with the plan

After treatment, follow-up visits matter: blood tests for inflammation (CRP and ESR) may be repeated until they return to normal, and imaging such as MRI or an echocardiogram may be repeated to monitor you. Continue all medicines as directed (NHLBI). Because NSAIDs and steroids are tapered gradually (Cremer et al., 2024, Andreis et al., 2021), a coach can help you keep a calendar of the schedule your doctor gives you. Keep a written list of every medicine, vitamin and supplement, and bring it to each visit (MedlinePlus).

Know your symptoms and your plan for them

Write down where to go and whom to call: 911 for chest pain with the heart attack signs or severe shortness of breath, and your provider for fever or chills, or shortness of breath, tiredness or leg swelling (NHLBI). A simple log of your symptoms may help you describe them to your doctor.

Activity pacing

Do not exercise until your provider says it is safe (NHLBI). Exercise restriction is considered important in recurrent pericarditis, because exertion may trigger relapses (Andreis et al., 2021). A coach can help you plan restful days and a gradual return once you are cleared.

Sleep and stress

Adults need 7 to 9 hours of sleep, and sleep helps heal and repair the heart and blood vessels (NHLBI). Stress-reducing activities such as talking with a counselor, relaxation techniques, meditation and support from friends and family can help; ask your provider which are safe for you (NHLBI).

Another approach

Fluid around the heart: effusion and tamponade

A pericardial effusion is extra fluid in the sac. Effusions range from mild and symptom-free to cardiac tamponade, and have many causes, including infection, cancer, autoimmune disease, metabolic problems and medicines (Imazio and Adler, 2013). In acute pericarditis a new or increased effusion is found in about 60% of people and is usually small (Cremer et al., 2024). A large effusion can progress to tamponade in up to a third of cases (Imazio and Adler, 2013).

Tamponade is when the fluid builds up enough to press on the heart and limit its pumping. It is a medical emergency (Adler et al., 2023).

Tell emergency staff you have pericarditis or an effusion. In people who already have an effusion, dehydration or certain medicines, particularly vasodilators or intravenous diuretics, can tip it into tamponade (Adler et al., 2023).

What it costs

Cost estimate being researched.

Another approach

Activity, exercise and return to sport

During an acute episode, rest from exercise is the standard advice. NHLBI says not to exercise until your provider tells you it is safe (NHLBI). One review calls exercise restriction critical for relieving inflammation, since exertion may trigger relapses, possibly through more rubbing of the inflamed layers at a higher heart rate (Andreis et al., 2021). A 2021 review notes that how exercise might harm an inflamed sac is still largely unknown, and compares U.S. and European recommendations on safely resuming activity (Grant and Shah, 2021).

Athletes. A sports-medicine review states that taking part in athletics is contraindicated during acute pericarditis, and that return to play is permissible once there is no evidence of active disease — confirmed by no fluid on echocardiography and normal blood markers of inflammation (Seidenberg and Haynes, 2006). A European position statement gives detailed advice for competitive and recreational athletes with myocarditis and pericarditis (Pelliccia et al., 2019). We could read only its summary, so we don’t give specific time periods here; your cardiologist or sports-medicine doctor should set yours.

Another approach

Recurrence and outlook

For most people the outlook is good. With NSAIDs and colchicine, most have a favorable course, although 15% to 30% develop a recurrence (Cremer et al., 2024). The risk can rise to about 50% in people with earlier recurrences, past steroid treatment or a non-viral cause (Andreis et al., 2021). NHLBI says pericarditis can return in the first 18 months after treatment, and that taking colchicine long term, if prescribed, may lower the risk of it coming back (NHLBI).

In unexplained (“idiopathic”) cases, serious complications are uncommon: one review puts the risk of tamponade under 2% and of constriction under 0.5% (Andreis et al., 2021). About 5% of people have persistent symptoms despite combinations of NSAIDs, colchicine and steroids; they are the hardest to treat and often need a team of specialists (Andreis et al., 2021). For these people, IL-1 blockers such as rilonacept are options (see Conventional medicine).

Recurrent pericarditis can hurt quality of life (Andreis et al., 2021). If you have repeated episodes, ask your doctor about a long-term plan and when to call.

What it costs

Cost estimate being researched.

Another approach

Constrictive pericarditis and surgery

In constrictive pericarditis, the sac around the heart itself limits how well the chambers can fill (Goldstein, 2004). It is rare after acute pericarditis (under 0.5% in one review) (Cremer et al., 2024) and is more frequent in people whose pericarditis was non-viral or never fully cleared (Andreis et al., 2021).

  • Medicines first, sometimes: when MRI shows the sac is still inflamed, there is a chance the constriction will ease with anti-inflammatory treatment, and one group found anakinra helped reverse constriction (Andreis et al., 2021).
  • Pericardiectomy — surgically removing the stiff sac — is considered a last alternative for chronic constriction or untreatable symptoms. One review says it is less effective after heart injury, in older age or when removal is incomplete, and carries a 5% to 10% operative death rate (Andreis et al., 2021).
  • What studies of surgery show: in a Montreal series of 99 people, hospital mortality was 9% and most survivors improved in function (Vistarini et al., 2015); in a series of 89 people, operative mortality was 7% and long-term survival depended on the cause (Szabó et al., 2013). These are single-center studies, so individual outcomes vary.

What it costs

Cost estimate being researched.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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