One bout of pericarditis can be a lot to deal with. But symptoms can come back. When it does, it’s known as recurrent pericarditis. It’s surprisingly common: Up to half of people with pericarditis in the United States--about 40,000 people--get it.
Most of the time, the first inflammation of recurrent pericarditis is idiopathic. That means medical experts don’t know what causes it. Still, there are some theories. Here’s what you should know.
What Are the Symptoms of Recurrent Pericarditis?
Recurrent pericarditis is when you get the symptoms again after going at least 4 weeks without them. Although you don’t have signs of pericarditis in between, you may still have inflammation of your heart's tissues, so you haven’t really recovered.
The main symptom of recurrent pericarditis is chest pain. It usually starts suddenly and is a sharp pain and gets worse when you cough or take a deep breath. It also gets worse when you lie down and gets better when you lean forward or sit. Other symptoms include:
- Shortness of breath
- Low-grade fever
- Fatigue
- Heart palpitations
- Swelling in the stomach, legs, or feet
- Dizziness or lightheadedness from low blood pressure
The symptoms of recurrent pericarditis are usually less intense than your first episode.
Why Does Pericarditis Recur?
Recurrent pericarditis happens as part of a cycle known as autoinflammation. It begins when the body's immune system mistakenly attacks the pericardium, causing it to become inflamed. The inflamed cells then release proteins that trigger another immune response that leads to yet more inflammation in a process that keeps repeating.
Some things seem to make this cycle more likely to start:
- A virus. Up to 20% of the time, a recurrence is due to a virus like the common cold, the flu, a stomach bug, or even herpes.
- An autoimmune condition like lupus or rheumatoid arthritis
- A heart attack
- Heart surgery
- Kidney failure
- Cancer
- HIV/AIDS
- Tuberculosis
- Certain antiseizure medicines like phenytoin, or blood thinners such as heparin or warfarin.
There are no risk factors that can predict recurrence, but some studies have shown that you may be more likely to have recurrent pericarditis if you’ve used long-term corticosteroids like prednisone to treat past episodes. As a result, many doctors try not to use it unless you can’t take NSAIDs for some reason (for example, you have kidney failure or you’re more than 20 weeks pregnant).
Women are also more likely to get recurrent pericarditis. They’re more likely to have autoimmune conditions that inflame the pericardium.
Recurrent pericarditis can sometimes be misdiagnosed. Because it’s an uncommon condition, health care providers may confuse the symptoms for anxiety or panic attacks. If this happens, your first episode of pericarditis may not be treated correctly. This makes it more likely that you’ll get it again.
How Do Doctors Know You Have Recurrent Pericarditis?
Your doctor will probably think you have recurrent pericarditis if you get chest pain again, especially if it’s chest pain that gets worse when you lie down and better when you lean forward. They’ll want to run some tests to know for sure. These include:
- Blood tests to check for signs of inflammation, such as your white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).
- Echocardiogram to check for pericardial effusion, or fluid around your heart.
- More advanced imaging, like a chest CT scan or cardiac MRI. Your doctor will do these if they can’t say for sure that you have recurrent pericarditis based on your symptoms or test results.
After an acute episode followed by a four- to six-week period without symptoms, your doctor will diagnose you with recurrent pericarditis if you have chest pain along with at least one of the following:
- Fever
- Pericardial rub, a sound your doctor might hear while listening to your heart
- ECG changes
- New or worsening pericardial effusion
- Abnormal blood tests that show inflammation
Once you’re diagnosed, the treatment for recurrent pericarditis may be similar to the treatment you got for your first bout of acute pericarditis. You may have to repeat treatments, have longer treatments, or try different options. Pericarditis can come back several times. This is why it’s important to keep up with your treatment and to see your cardiologist regularly, so they can be sure that the inflammation is completely gone.
Sometimes it takes five to seven years to treat patients who have multiple recurrences. Talk to your doctor about newer medications, such as interleukin-1 inhibitors. They may prevent your pericarditis from coming back again.
Show Sources
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SOURCES:
National Organization for Rare Disorders: “Recurrent Pericarditis.”
American Heart Association: “Recurrent Pericarditis,” “Recurrent Pericarditis: It Doesn’t Just Wish Away.”
UptoDate: “Acute Pericarditis: Treatment and Prognosis,” “Recurrent Pericarditis,” "Patient education: Pericarditis (Beyond the Basics)."
American College of Cardiology: “The paradigm shift in the management of recurrent pericarditis.”
Current Cardiology Reports: Rilonacept (interleukin-1 inhibition) for the treatment of pericarditis.”
Nature Reviews Rheumatology: "IL-1 and autoinflammatory disease: biology, pathogenesis and therapeutic targeting."
