Massive chest pain that feels like a heart attack might be something else:  acute pericarditis, a potentially life-threatening inflammation of the sac around the heart that causes the sac to become hardened and thickened - or possibly a more serious condition called constrictive pericarditis, in which the heart feels as if it’s being strangled.

These pericardial clinical conditions may be due to a variety of reasons ranging from viral infections to the aftereffects of surgery, says Allan Klein, MD, Director of Cardiovascular Imaging Research at Cleveland Clinic. Doctors use magnetic resonance imaging (MRI), echocardiography, as well as inflammatory markers to gauge severity of the condition and appropriate therapy.

With the pain of acute pericarditis, Dr. Klein says that patients can be in the fetal position and unable to take a breath.  “The pain goes to the left shoulder, and they have to sit forward for relief.”

With constrictive pericarditis, patients have elevated veins in the neck as well as abdominal or leg swelling.  

Since its symptoms are similar to those of other cardiac and pulmonary diseases, pericarditis can be difficult to diagnose.  Dr. Klein recently worked with a group of experts to develop a new consensus statement for the American Society of Echocardiography to help physicians pinpoint the condition.  The report outlines evidence-based guidelines to help primary care doctors and cardiologists identify the condition.

Dr. Klein notes that pericarditis can affect young people (even teenagers) as well as 60- and 70-year-olds. “I even had a high-schooler who had to miss a year of school.”

A triple therapy of drugs including NSAIDs, prednisone and colchicine, work to reduce the inflammation and prevent the need for surgery.  In other cases of advanced constrictive pericarditis, full removal of the sac, known as a pericardiectomy, is performed.

The heart sac helps protect the heart from infection but is not necessary to live.

Unlike many conditions, Dr. Klein adds, exercise is not recommended for acute or recurrent pericarditis sufferers when there is active inflammation.  “You don’t want to move around too quickly,” he says.  “Exercise is the worst thing.”