Quick answer. Pericarditis is inflammation of the pericardium, the thin sac around the heart, causing sharp chest pain that often eases when you sit forward. It is usually viral and treatable, but because its chest pain can mimic a heart attack, sudden severe symptoms must be treated as an emergency.
Pericarditis is inflammation of the sac that surrounds the heart, and it typically causes a sharp, stabbing chest pain that is often worse lying down and better when you sit up and lean forward. Although most cases are viral and settle with anti-inflammatory medication, the chest pain of pericarditis can closely resemble a heart attack – so it always deserves to be taken seriously.
This guide explains what pericarditis is, what causes it, how cardiologists in Singapore diagnose it, and how it is treated. Crucially, it also sets out the red-flag symptoms that mean you should call 995 straight away, because severe chest pain should never be assumed to be “just” pericarditis until a heart attack and other serious causes have been excluded.
At a glance
| Feature | Typical pericarditis | Warning sign – act now |
|---|---|---|
| Chest pain | Sharp, eased by sitting forward | Crushing, pressure-like, or radiating to arm or jaw |
| Breathing | Pain worse on deep breath, but breathing manageable | Severe breathlessness or gasping |
| Position | Worse lying flat, better leaning forward | Pain that does not change and is severe |
| Associated symptoms | Mild fever, tiredness after a viral illness | Sweating, nausea, fainting or collapse |
| What to do | See a doctor or cardiologist promptly | Call 995 – treat as a possible heart attack |
What is pericarditis?
Pericarditis is inflammation of the pericardium – the thin, two-layered sac that surrounds and protects the heart. When this sac becomes inflamed, the layers can rub together and a small amount of fluid may collect, producing the characteristic sharp chest pain.
It can affect people of any age but is seen more often in younger and middle-aged adults, and more commonly in men. Most cases are acute, meaning they come on over hours to days and settle within a few weeks. Some people have recurrent episodes. Pericarditis is usually mild and treatable, but because it sits so close to the heart and shares symptoms with more dangerous conditions, it is always assessed carefully.
Symptoms & signs
The hallmark of pericarditis is chest pain with a distinctive pattern. Common features include:
- Sharp or stabbing chest pain, usually behind the breastbone or on the left side
- Pain that is worse when lying flat, breathing deeply, coughing or swallowing
- Relief when sitting up and leaning forward
- Pain that may spread to the neck, shoulder or back, especially the left shoulder
- A low-grade fever, often after a recent viral or flu-like illness
- Tiredness, a general feeling of being unwell, and sometimes a dry cough
- Palpitations or a sense of the heart racing
Because some of these overlap with a heart attack, new or severe chest pain should always be checked by a doctor.
Causes & risk factors
In many cases the exact cause is never identified, and these are presumed viral. Recognised causes and triggers include:
- Viral infections, the most common identifiable cause, often after a cold or flu-like illness
- Bacterial, fungal or other infections (less common)
- Autoimmune and inflammatory conditions such as lupus or rheumatoid arthritis
- A recent heart attack or heart surgery
- Kidney failure with a build-up of waste products in the blood
- Chest injury or radiotherapy to the chest
- Certain medicines and, occasionally, cancer affecting the pericardium
A previous episode of pericarditis also raises the chance of a recurrence.
How it's diagnosed
A doctor will start with your history and a physical examination, listening to the heart with a stethoscope – pericarditis can produce a characteristic scratchy sound called a pericardial rub. To confirm the diagnosis and rule out a heart attack, tests usually include:
- ECG (electrocardiogram): records the heart’s electrical activity and often shows changes typical of pericarditis.
- Blood tests: inflammatory markers, and heart-specific markers (troponin) to help distinguish pericarditis from a heart attack.
- Echocardiogram: an ultrasound of the heart to check for fluid around it (a pericardial effusion) and how the heart is functioning.
- Chest X-ray: to look at the heart size and the lungs.
- CT or cardiac MRI: in selected cases to assess the pericardium in more detail.
Treatment options
Most cases of viral or unexplained pericarditis improve with rest and anti-inflammatory medication. Treatment commonly involves:
- Anti-inflammatory medicines (NSAIDs): such as ibuprofen or aspirin to reduce inflammation and pain, usually for a few weeks.
- Colchicine: often added to speed recovery and reduce the risk of the pericarditis coming back.
- Rest: avoiding strenuous activity until symptoms settle.
- Treating the underlying cause: for example antibiotics for a bacterial cause, or managing an autoimmune condition.
- Steroids or other medicines: reserved for recurrent or harder-to-treat cases under specialist care.
If a large amount of fluid collects around the heart and affects its pumping (a complication called cardiac tamponade), it may need to be drained urgently in hospital. Because individual treatment depends on the cause and severity, decisions should be guided by a doctor or cardiologist rather than self-prescribed.
When to see a doctor & which specialist
Any new, severe or persistent chest pain should be assessed promptly, because it is not safe to assume chest pain is “only” pericarditis. Call 995 immediately if you have severe or crushing chest pain, chest pain that spreads to the arm, neck or jaw, sudden severe breathlessness, sweating, fainting or collapse – these could signal a heart attack or a serious complication of pericarditis and must be treated as an emergency.
See a doctor without delay for milder but new chest pain, especially after a viral illness, so an ECG and other tests can confirm the cause. Once pericarditis is diagnosed, a cardiologist can guide treatment, watch for fluid around the heart, and manage recurrent cases.
To find a heart specialist, see our directory of the best cardiologists in Singapore.
Related guides
- Best Cardiology Clinics in Singapore — our editorial shortlist
- cardiology clinics directory
- Blepharitis
- Interstitial cystitis
- Phimosis
- Peyronie's disease
- OCD
Sources
- NHS – Pericarditis
- Mayo Clinic – Pericarditis
- SingHealth – Heart Conditions and Treatments
- HealthHub Singapore – Heart Health
Part of our Heart & vascular guides · Browse all health topics