Acute Pericarditis Pain: Causes, Characteristics, and Management

Acute pericarditis is a condition characterized by inflammation of the pericardium — the thin, double-layered sac that surrounds the heart. One of the most prominent symptoms of this condition is chest pain, which can vary in intensity and presentation. Understanding the causes and characteristics of this pain is essential for accurate diagnosis and effective treatment.

What Causes Pain in Acute Pericarditis?

The heart is naturally enclosed in a protective sac called the pericardium, which consists of two layers: the visceral layer (attached to the heart muscle) and the parietal layer (outer lining). Under normal conditions, these layers glide smoothly over each other thanks to a small amount of lubricating pericardial fluid in between.

However, during acute pericarditis, inflammation causes these layers to become rough and irritated. This leads to friction between the visceral and parietal layers, especially during heartbeats. The resulting irritation and pulling can cause significant chest discomfort. In some cases, adhesions may form between the layers, further contributing to the pain during movement or breathing.

Key Characteristics of Pericarditis-Related Chest Pain

Type and Location of Pain

The pain associated with acute pericarditis is typically located behind the sternum or in the left side of the chest (precordial area). It is often described as sharp or stabbing, although it can also present as a dull ache or a crushing sensation similar to angina.

Pain Radiation and Triggers

In some cases, the discomfort may radiate to the left shoulder or upper arm. Importantly, the pain can be influenced by body position and respiratory movements. It often worsens when lying flat, taking deep breaths, or coughing. Conversely, sitting up and leaning forward can provide some relief, a distinguishing feature that helps clinicians differentiate pericarditis from other cardiac conditions like myocardial infarction.

Why Accurate Diagnosis Matters

Because the symptoms of pericarditis can closely mimic those of a heart attack, it is crucial to seek prompt medical evaluation. Physicians often rely on a combination of patient history, physical examination, electrocardiogram (ECG) findings, and imaging studies to make an accurate diagnosis and rule out more life-threatening conditions.