What Comes Next: Pericardial Disease

Reviewed by the Columbia Center for Pericardial Diseases Faculty, November 2025

Being diagnosed with pericardial disease can raise a lot of questions: how serious it is, what causes it, and will it affect your long-term heart health? Fortunately, pericardial conditions are fairly common and very treatable.

Our What Comes Next series is designed to answer common questions and help you feel more informed and supported as you take the next steps in your care.

I’ve Been Diagnosed with Pericardial Disease. How Serious Is It?

It depends on the type and cause of your pericardial disease. The pericardium is the thin, double-layered sac that surrounds and protects your heart. When it becomes inflamed, filled with fluid, or stiffened by scar tissue, it can affect how the heart functions.

There are several types of pericardial disease:

• Pericarditis: inflammation of the pericardium, often causing sharp chest pain
• Pericardial effusion: buildup of fluid around the heart
• Cardiac tamponade: a severe form of effusion that compresses the heart and requires urgent treatment
• Constrictive pericarditis: when the pericardium becomes thick and stiff, restricting the heart’s movement

Most cases are mild and temporary, but some can become serious if fluid builds up or scarring develops.

What Causes Pericardial Disease?

There are many possible causes, including:

• Viral infections (the most common cause of acute pericarditis)
• Autoimmune or inflammatory conditions (like lupus or rheumatoid arthritis)
• After a heart attack or heart surgery
• Cancer or radiation therapy (less common)
• Kidney failure or hypothyroidism
• Certain medications or trauma to the chest

Sometimes, there is no specific known cause. This is called idiopathic pericarditis, and it often resolves on its own with medication.

I Feel Fine. Should I Be Concerned?

Some people experience mild pericardial inflammation without significant symptoms. Even if your symptoms are mild, it’s important to follow up with your cardiologist. Cardiac imaging, such as echocardiograms or MRI, can help make sure your heart is not under pressure from fluid buildup.

Pericarditis returns after a first episode about 25% of the time; so, it’s important that you discuss treatment options with your doctor even when you are not feeling any pain to prevent new episodes. 

Tell your doctor if you start to feel chest discomfort, especially when breathing deeply or lying down. Other common symptoms include:

• Sharp, stabbing chest pain that improves when sitting forward
• Shortness of breath or fatigue
• Swelling in the abdomen or legs (in more advanced cases)
• A sense of pressure or fullness in the chest

Will I Need a Procedure?

In most cases, no. Most people with pericardial disease get better with medications - usually anti-inflammatory treatments like ibuprofen, colchicine, and sometimes steroids or newer FDA-approved therapies if symptoms continue. 

A procedure is only needed in specific situations, such as:

• A large pericardial effusion (extra fluid around the heart) that needs to be drained with a procedure called pericardiocentesis
• Constrictive pericarditis, where the pericardium becomes stiff and restricts the heart’s movement. In these cases, surgeons may recommend removing the  pericardium (pericardiectomy). However, some patients can be treated successfully with medications alone; this is where evaluation at a specialized pericardial center is especially important.

Your care team will tailor treatment to your specific condition and cause.

What Are the Treatment Options?

Treatment depends on the type and cause of pericardial disease, but usually starts with colchicine and NSAIDs, which are highly effective for most patients.

In recurrent cases, additional therapies such as steroids or IL-1 inhibitors may be recommended. In some cases, a comprehensive evaluation is needed to make sure there is no underlying autoinflammatory or autoimmune condition, as these require a tailored treatment approach.

Other treatment options can include:

• Antibiotics if an infection is present
• Pericardiocentesis, a procedure to remove excess fluid around the heart
• Pericardiectomy, a surgery to remove part or all of the pericardium in rare long-term or constrictive cases
• Treating the underlying cause, such as autoimmune disease, kidney disease, or cancer

Rest and avoiding strenuous activity are often recommended until inflammation improves.

Can Medications Cure It?

Yes, in most cases, medications can fully resolve pericarditis or mild effusions. Chronic or recurrent cases may require longer-term treatment or additional procedures. But most patients recover completely once the inflammation or fluid is treated.

How Will I Know If It’s Getting Worse?

Let your doctor know right away if you notice:

• Worsening chest pain or shortness of breath
• Rapid heartbeat or feeling faint
• Swelling in your legs, abdomen, or neck veins
• Any return of symptoms after initial improvement

Your cardiologist may repeat echocardiograms or other imaging tests to track your progress and confirm that the pericardium is healing.

Will I Feel Better After Treatment?

Yes. Most patients feel significantly better within days to weeks, especially once inflammation and pressure on the heart are relieved. If your heart function was affected by fluid buildup or scarring, you may notice gradual improvement over several months.

Will Treatment Help Me Live Longer?

Yes. When treated promptly and appropriately, most people with pericardial disease recover fully and go on to live normal, healthy lives. Serious complications—like cardiac tamponade or constrictive pericarditis—are rare when the condition is recognized early and managed carefully.

While a first episode of pericarditis usually responds well to standard therapy, recurrent cases often require deeper evaluation and a more specialized treatment plan. A coordinated team—often including cardiologists who specialize in inflammatory heart conditions, rheumatologists, advanced imaging experts, and cardiac surgeons when appropriate—can guide you through each step and help prevent future flare-ups.

Related

• Columbia Center for Pericardial Diseases
• What Comes Next: Aortic Stenosis
• Columbia #3 Globally in Cardiac and Cardiovascular Systems