Pericarditis is inflammation of the tissue around the heart, or pericardium. The pericardium holds the heart in place and helps it function. People with chronic pericarditis require ongoing rest and care.

The pericardium is a sac consisting of two layers of tissue separated by fluid, which helps reduce friction. During pericarditis, these layers experience inflammation, which can cause them to rub against each other or the heart.

This article explores the types of chronic pericarditis and their symptoms and treatments. It also discusses when to contact a doctor and tips for maintaining good heart health.

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There are several types of longer-lasting or complicated pericarditis.

Chronic vs. recurrent pericarditis

According to a 2021 literature review, clinicians define pericarditis as chronic if symptoms continue for more than 3 months.

In contrast, recurrent pericarditis is characterized by regular flares up with symptom-free periods lasting for at least 4–6 weeks. Up to 30% of people with acute pericarditis can experience recurrent pericarditis.

Pericardial effusion

Also known as cardiac tamponade, pericardial effusion involves a buildup of fluid in the pericardial sac. This can affect the movement of blood through the chambers of the heart, causing a rapid drop in blood pressure. If the sac fills up too much, it can completely block the heart, leading to a medical emergency.

Chronic constrictive pericarditis

People with this type of pericarditis experience scarring on the pericardium. This causes it to become thicker and less elastic, reducing its efficiency. Chronic constrictive pericarditis develops slowly over time.

In rare cases, people may develop constrictive-effusive pericarditis. This type can cause both thickening and filling of the heart sac. It is typically a chronic condition that requires surgical treatment.

Symptoms of chronic pericarditis differ from those of acute pericarditis.

Other symptoms might include:

  • fatigue, or extreme tiredness
  • breathlessness
  • coughing

People with severe chronic pericarditis may experience edema, or swelling in the legs, ankles, feet, and belly. Low blood pressure might also occur.

Pericarditis can be acute, lasting only for a short while. However, some people can have pericarditis for as long as months or even years.

Treatment for chronic pericarditis can take many years. People with the condition may receive around 4.7 to 6.2 years of treatment with anti-inflammatory medications, according to a 2023 analysis. During this time, careful management and lifestyle adjustments may be necessary to prevent complications.

Treatment for chronic pericarditis often involves surgery to treat constriction or effusion.

Treatment for acute pericarditis aims to use medications to relieve pain and inflammation, and to address the underlying infection. This often involves:

  • aspirin and ibuprofen, for mild pericarditis
  • colchicine, a stronger anti-inflammatory medication for more severe pericarditis
  • prednisone, a steroid for more severe pericarditis
  • interleukin-1 (IL-1) inhibitors, to suppress the immune system in people who do not respond to other medications


This surgical procedure helps to treat pericardial effusion. During the procedure, a doctor inserts a tube or needle into the wall of the chest. They then drain excess fluid from the pericardium. They may also carry out other procedures to remove fluid from around the heart. This helps to relieve pressure on the heart and restore normal function.


This is the only cure for chronic constrictive pericarditis. It is usually a last resort when symptoms become severe. In a pericardectomy, a surgeon removes the pericardium.

The American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines for pericarditis recovery mainly focus on athletes.

The ESC recommends 3 months of restricted activity for professional athletes, starting from the first attack. People who are not professional athletes should restrict physical activity until symptoms resolve.

It is also important for people with chronic pericarditis to monitor their heart health in general. A slow return to exercise after recovery can help people protect their heart. Other protective steps might include:

  • choosing a diet high in fiber and low in:
    • salt
    • sugar
    • saturated and trans fats
    • cholesterol
    • alcohol
  • maintaining a healthy body weight within a normal body mass index (BMI) range
  • avoiding or quitting smoking
  • regularly checking cholesterol levels, blood sugar, and blood pressure to monitor metabolic health

People should speak with a doctor about any medications or treatments that may be necessary to manage general heart health following a chronic pericarditis diagnosis.

Anyone experiencing chest pain should contact a physician, as it may be a heart attack.

Unlike acute pericarditis, people with chronic pericarditis do not always experience chest pain. However, if they do, the pain may sit in the center or left of the chest. It may feel better when a person sits up or leans forward.

Pericarditis pain may also feel like:

  • stabbing
  • sharpness
  • aching
  • pressure

People experiencing any of these symptoms should seek medical attention. People experiencing the following symptoms should also contact emergency services:

  • pain that spreads to the back, neck, jaw, or arms
  • tightness or heaviness in the chest
  • breathlessness
  • sweating
  • nausea
  • pain lasting longer than 15 minutes

Chronic pericarditis refers to inflammation of the outer layer of the heart that lasts for longer than 3 months. It occurs when scarring causes this layer to thicken, or the sac fills with fluid.

Surgery is usually necessary to treat chronic pericarditis. After surgery, it is important for people to rest and avoid exertion until symptoms improve and diagnostic tests show normal results.

People experiencing chest pain should contact their doctor.