Recurrent pericarditis: What to know

The pericardium is a sac-like structure that surrounds the heart and holds it in place. It is made up of two thin layers of tissue. When it becomes inflamed, it is known as pericarditis.

Pericarditis is typically a chronic condition, meaning it is long lasting and will typically require long-term management.

A person may experience an episode of pericarditis that resolves for a minimum period of 4 weeks, during which time they have no symptoms. If they then experience a second episode, typically referred to as a flare, they may have recurrent pericarditis.

Recurrent pericarditis affects 15% to 30% of people with acute pericarditis, and 50% of those people experience multiple flares.

The cause of the first acute episode of pericarditis is often unknown, but experts believe that recurrent episodes may result from:

Autoimmune conditions may contribute to recurrent pericarditis. An autoimmune disease occurs when the immune system mistakenly attacks the body. Examples of autoimmune diseases associated with pericarditis include:

An autoinflammatory response occurs when the body experiences uncontrolled inflammation. Autoinflammatory conditions are rare and may have an inherited component. Familial Mediterranean fever (FMF) is the condition most commonly associated with recurrent pericarditis.

The most common symptom of pericarditis is chest pain that becomes worse when lying down, coughing, or breathing deeply.

No matter how many times a person has a pericarditis flare, the symptoms can be the same. Other common symptoms include:

People may also experience symptoms of low blood pressure, including feeling lightheaded, dizzy, or faint.

Additionally, anecdotal evidence suggests that many people with pericarditis are misdiagnosed with acid reflux or heartburn, with females reportedly receiving an incorrect diagnosis of a panic attack, anxiety, or stress.

After requesting a person’s medical history and performing a general physical examination, a doctor or another healthcare professional can often use a stethoscope to listen to the heart for a “rubbing” sound that may indicate pericarditis.

Up-to-date guidance on diagnostic tests includes cardiac magnetic resonance (CMR) imaging, which may help detect inflammation and assess disease activity in recurrent and difficult cases.

Recent guidance strongly recommends colchicine alongside a high dose of non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin (ASA), as first-line therapy for most people with recurrent or acute pericarditis.

Colchicine is available as a generic medication — as capsules or tablets — under the brand names Colcrys, Mitigare, and Lodoco, as well as a liquid form called Gloperba.

Doctors typically prescribe colchicine for 6 to 12 months for recurrent pericarditis, with high dose anti-inflammatories being tapered down once pain and blood test results improve.

Experts advise that people with recurrent pericarditis try to keep their heart rate below 100 beats per minute during their recovery.

If a person has recurring pericarditis, it is often because they have not fully recovered from the initial acute episode or because inflammation has increased, known as an autoinflammatory response.

Many people with recurrent pericarditis can successfully manage their condition at home.

It is important that Individuals speak with a doctor or another healthcare professional if they are concerned about their health and call 911 if they experience chest pains.

The medication colchicine may help prevent pericarditis flare-ups, along with aspirin and NSAIDs.

If a person has an underlying health condition, addressing this may prevent pericarditis from recurring.

Once an individual is diagnosed with recurrent pericarditis, they will usually be in regular contact with their healthcare team for treatment and general health condition management.

If a person feels any type of chest pain, they should immediately call 911 — or their local emergency number — in case it is a heart attack.

In recent years, following important clinical trials, interleukin-1 (IL-1) blockers have proven effective in the treatment of recurrent pericarditis that is nonresponsive to colchicine and corticosteroid-dependent, although this medication cannot be given to those:

The specific IL-1 inhibitors for recurrent and inflammatory pericarditis include rilonacept and anakinra.

These medications work by preventing inflammation and often providing fast pain relief. They may also ensure fewer recurrences.

Recurrent pericarditis occurs when the pericardium becomes inflamed following a symptom-free period of a minimum of 4 weeks after an initial episode. Healthcare professionals may refer to recurring episodes as “flares.”

Preferred treatment is with colchicine, non-aspirin NSAIDs, and aspirin, but in some instances, IL-1 inhibitors may prove more successful.

People living with recurrent pericarditis will usually have a care plan in place, so it is important they adhere to it and keep their healthcare team informed of any changes in their condition.

If a person experiences chest pain, they should call 911 right away in case it is a heart attack.