Pericarditis and myocarditis: What’s the difference?

Myocarditis and pericarditis are both inflammatory conditions that affect the heart, however they affect different areas of this organ.

Here to explain them in further, expert detail is leading associate specialist in cardiology Dr Francesco Lo Monoco.

What is pericarditis?

It is the inflammation and swelling of the thin, saclike tissue which surrounds the heart, called the pericardium. Chest pain, which is common symptom of pericarditis, is caused by the inflamed layers of the pericardium rubbing against each other.

Medication and on rare occasion, surgery, may be used to treat more severe cases. However, pericarditis is usually mild and resolves by itself.   

Lowering the risk of long-term consequences may work via early detection and treatment of pericarditis. MRIs, CT scans and transthoracic echocardiograms can be used to detect pericarditis, alongside simple stethoscope readings to detect the ‘pericardial rub’.  

What are the symptoms of pericarditis?

The primary symptom of pericarditis is chest pain; stabbing chest pain in particular. It may include increased chest pain upon coughing or inhalation. Other symptoms can manifest as:

• Back pain around the shoulder blades

• A cough that’s dry

• Palpitations in the heart

• Fatigue

• Fever

• Sore through

• Shortness of breath

Acute pericarditis lasts for three weeks or less, and it appears rapidly. Also, it’s possible to have future episodes. It can be difficult sometimes to distinguish acute pericarditis pain from the pain caused by a heart attack.      

Recurrent pericarditis develops over four to six weeks following an episode of acute pericarditis, with no symptoms in the interim. Incessant pericarditis lasts between four to six weeks but less than three months. Also, the signs and symptoms don’t stop (hence the word recurrent).  

Pericarditis that’s determined as chronic constrictive pericarditis, is characterised by a gradual onset. Plus, it can last for more than three months.

How is myocarditis defined?

It’s heart muscle inflammation (myocardium), which can impair the heart’s ability to pump blood. This results in fast or irregular heartbeats, or arrhythmias, and it can produce blood clots. This can lead to a heart attack, stroke or heart damage – and in severe cases, death.

During a physical examination, myocarditis can be detected - or at least suspected – due to indications of swelling in the legs and feet, or an irregular heartbeat. Your doctor might send you for an X-ray, ECG, MRI or transthoracic echocardiogram test if myocarditis is suspected.   

What are myocarditis’ symptoms?

It can sometimes present without any other symptoms, apart from feet and leg swelling, or pleuritic chest pain. The most common symptoms of myocarditis include rapid or irregular heartbeat, fatigue and joint stiffness as well as shortness of breath and light-headedness.  

Other symptoms of myocarditis can include:

• Fever

• Headache

• Sore throat

• Body aches

It can be acute or chronic. Acute myocarditis resolves more easily, and it’s generally classified this way when the time between symptoms appearing and the time you are diagnosed is less than a month. After treatment, the majority of acute myocarditis cases improve directly or shortly afterwards.

When your symptoms persist or become increasingly difficult to manage, this is what’s known as chronic myocarditis. It appears to be related to the response of the immune system, while in reality, it’s frequently connected to autoimmune illnesses. This can lead to an increase in body inflammation.

What are the differences between pericarditis and myocarditis?

The two conditions have many similarities, and they can be interrelated because both of them are heart conditions. Myocarditis is an inflammation of the heart muscle, while pericarditis is an inflammation of the heart’s lining, to put it simply.

Pericarditis and myocarditis are usually secondary to a viral infection, like COVID, and have become very common. Both conditions usually present with symptoms such as chest pain, and can also cause shortness of breath and heart palpitations. Chronic inflammatory issues such as arthritis, lupus or other disease may also cause pericarditis and myocarditis.

How is pericarditis and myocarditis diagnosed?    

If you’re suffering from either pericarditis or myocarditis, or both, your doctor will be able to find out. What’s the most important is that you see a physician that can recommend that correct course of action and book the right tests, whether that’s a blood test or a private transthoracic echocardiogram test, for you.

If you’re concerned about either pericarditis or myocarditis arrange a consultation with Dr Lo Monaco, who can expertly address your queries, by visiting his Top Doctors profile.