From the Guidelines
Pericardial pain is not muscular, but rather originates from inflammation of the pericardium, which is the thin, sac-like membrane that surrounds the heart. This type of pain is typically described as sharp and stabbing in the center or left side of the chest, and often worsens when lying down, taking deep breaths, coughing, or swallowing, as noted in the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1. It may improve when sitting up and leaning forward. Pericardial pain is caused by conditions like pericarditis (inflammation of the pericardium), which can result from viral infections, autoimmune disorders, heart attacks, trauma, or certain medications.
Some key differences between pericardial pain and muscular chest pain include:
- Location: Pericardial pain is typically felt in the center or left side of the chest, while muscular chest pain can occur in any area of the chest wall
- Triggers: Pericardial pain is often worsened by lying down, taking deep breaths, coughing, or swallowing, while muscular chest pain may be triggered by movement or pressure on the affected muscles
- Characteristics: Pericardial pain is typically sharp and stabbing, while muscular chest pain may be dull and aching
In contrast, muscular chest pain is typically associated with muscle strain or injury, and may be characterized by pain that changes with movement or pressure on the affected muscles, as described in the 2017 AHA/ACC key data elements and definitions for ambulatory electronic health records in pediatric and congenital cardiology 1. Treatment for pericardial pain typically includes anti-inflammatory medications like ibuprofen or aspirin, and in some cases, colchicine may be prescribed to reduce inflammation and prevent recurrence. If you experience chest pain, it's essential to seek medical attention promptly to determine the exact cause and appropriate treatment.
From the Research
Pericardial Pain Characteristics
- Pericardial pain is often described as sharp, stabbing, or pressing, and can be localized to the chest or radiate to the arms, neck, or back 2, 3, 4, 5, 6
- The pain can be exacerbated by deep breathing, coughing, or movement, and may be relieved by sitting up or leaning forward 2, 3, 4, 5, 6
Muscular Component of Pericardial Pain
- While pericardial pain is primarily associated with inflammation of the pericardium, there is evidence to suggest that muscular factors may also contribute to the pain experience 2, 3, 4, 5, 6
- The pericardium is surrounded by muscles, including the diaphragm and intercostal muscles, which can become irritated or inflamed in response to pericardial disease 2, 3, 4, 5, 6
- Treatment of pericardial pain often involves anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine, which can help to reduce inflammation and relieve pain 3, 4, 5, 6
Treatment of Pericardial Pain
- The primary goal of treatment for pericardial pain is to reduce inflammation and relieve symptoms 2, 3, 4, 5, 6
- Treatment options may include:
- NSAIDs or aspirin to reduce inflammation and relieve pain 2, 3, 4, 5, 6
- Colchicine to reduce inflammation and prevent recurrences 3, 4, 5, 6
- Glucocorticoids or immunosuppressive agents in severe or refractory cases 2, 3, 4, 5, 6
- Anti-interleukin-1 agents, such as anakinra or rilonacept, in cases of recurrent pericarditis refractory to conventional treatment 6