If you’ve had a bout of pericarditis, you probably have already spent time in the ER. One thing you may worry about is what you should do if you think your pericarditis has recurred, or come back.
It’s something you should keep in mind. About one-fourth of patients who had a pericarditis episode will have another one within two years, and 15% will have multiple recurrences. Most of the time, these recurrences are milder.
Here are some of the signs of recurrent pericarditis and how to know when it’s an emergency.
What Are the Signs of Recurrent Pericarditis?
If you’ve had an episode of pericarditis, your cardiologist will most likely watch you closely. They’ll look for changes in your heart’s tissue so that they can create a treatment plan to prevent recurrences.
You should still be on the alert for symptoms of pericarditis. These include:
- Chest pain that can feel like a sharp or dull ache that gets worse when you lie down but better if you sit up or lean forward
- Shortness of breath
- Heart palpitations, your heart may feel like it’s going faster than normal
- Fever
- Cough
- Swollen stomach, legs, or feet
- Lightheadedness, dizziness, or fainting
The most common symptoms of recurrent pericarditis tend to be chest pain, especially after exercise, as well as shortness of breath.
When Should You Go to the Emergency Room for Pericarditis?
There are some differences between pain related to recurrent pericarditis and pain from a heart attack. Pericarditis usually gets worse when you lie flat on your back and feels better when you lean forward. Chest pain from a heart attack, on the other hand, doesn’t get better when you change position. It may cause pain that radiates to your arms, back, neck, jaw, or stomach.
Symptoms can vary for everyone, so don’t try to diagnose yourself. Either condition, if left untreated, can lead to serious complications. Head to the ER.
If you don’t have chest pain, you should still call your doctor if you notice other possible pericarditis symptoms, such as swelling in your legs or feet or heart palpitations.
What Can I Expect if I Go to the ER for My Recurrent Pericarditis?
The medical staff at the ER will run tests to rule out a heart attack and confirm that it is pericarditis. These include:
- Blood tests that look for signs of inflammation, such as white blood cells or C-reactive protein
- An electrocardiogram (EKG) to look at your heart’s electrical activity and see if it shows signs of either a heart attack or pericarditis
- A chest X-ray to look for extra fluid in your pericardium
- An echocardiogram to look at your heart’s size, shape, and functioning
- A cardiac CT to take a picture of your heart
- A cardiac MRI, which can show changes in your pericardium
All of these tests can also look for potentially life-threatening complications of recurrent pericarditis. Although rare, these include:
- Pericardial effusion, or fluid buildup around the heart.
- Constrictive pericarditis, where the lining of your pericarditis thickens and forms scars that keep your heart from functioning properly.
- Cardiac tamponade, or pressure on your heart from fluid buildup around the pericardium sac that stops it from filling properly. Less blood leaves your heart, which causes your blood pressure to drop sharply.
Will I Need to Be Hospitalized for My Recurrent Pericarditis?
Your doctor may want to admit you to the hospital if you have any of the above complications, or a high fever. Otherwise, you can get better at home. Treatment may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin. You may also use these with a prescription anti-inflammatory drug, colchicine.
Corticosteroids. If an NSAID-colchicine combination doesn’t work, your doctor may want to add these drugs. But they’re linked to a higher risk of recurrence, so their use is mainly limited to people who are pregnant or have auto-immune conditions.
Biologics and immunosuppressants. The biologic drug rilonacept (Arcalyst) is a newer treatment for this condition. It’s a type of drug called an interleukin-1 (IL-1) inhibitor. It traps cytokines, which are the inflammatory compounds in your body that can cause pericarditis. Another option is a drug that suppresses your immune system, such as azathioprine.
Surgery. In serious cases, you may need this to drain your pericardium or to remove it.
You may also need to be hospitalized if you don’t respond to anti-inflammatory medications within about a week. If you have cardiac tamponade, you’ll need to have your pericardium drained immediately.
If you think you have recurrent pericarditis, head to the emergency room. The good news is once it’s diagnosed and you begin treatment, your chances of recovery are excellent.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Journal of the American Heart Association: “US Database Study of Clinical Burden and Unmet Need in Recurrent Pericarditis.”
UptoDate: “Recurrent Pericarditis,” “Constrictive Pericarditis: Diagnostic Evaluation,” “Cardiac Tamponade.”
Myocarditis Foundation: “Pericarditis Recovery: What to Expect.”
American Heart Association: “What Causes Chest Pain?” “Signs and Symptoms of Pericarditis,” “Recurrent Pericarditis.”
FDA: “FDA approves first treatment for disease that causes recurrent inflammation in sac surrounding heart.”
