• Chest pain, caused by the inflamed pericardium rubbing against the heart.
  • Usually relieved with sitting
  • Pleuritis type: a sharp, stabbing pain
  • May radiate to the neck, shoulder, back or abdomen
  • Increases with deep breathing
• Breathing difficulty when lying down (the patient prefers standing or sitting upright)
• Splinting of ribs (bending over or holding the chest) with breathing
• Dry cough
• Difficulty swallowing
• Hiccups
• Ankle, feet and leg swelling (occasionally)
• Anxiety
• Fatigue
• Fever

When listening to the heart with a stethoscope, the health care provider can hear a typical sound called a pericardial rub. The heart sounds may be muffled or distant. There may be other signs of fluid in the pericardium (pericardial effusion).

If the disorder is severe, there may be crackles in the lungs, decreased breath sounds, or other signs of fluid in the space around the lungs (pleural effusion).

If fluid has accumulated in the pericardial sac, it may show on:

• Chest x-ray
• Echocardiogram
• Chest MRI scan
• Heart MRI or heart CT scan
• Radionuclide scanning

These tests show enlargement of the heart from fluid collection in the pericardium, and signs of inflammation. They may also show scarring and contracture of the pericardium (constrictive pericarditis). Other findings vary depending on the cause of pericarditis.

An ECG is abnormal in 90% of patients with acute pericarditis. The ECG changes generally evolve in stages during the disease process, and they may mimic the ECG changes of a heart attack. To rule out heart attack, serial cardiac marker levels (CK-MB and troponin I) may be ordered. Other laboratory tests may include:

• blood culture
• CBC, may show increased WBC count
• C-reactive protein
• erythrocyte sedimentation rate (ESR)
• pericardiocentesis with chemical analysis and pericardial fluid culture