Pericarditis is an inflammatory condition of the outer covering or membrane that houses the heart. The inflammation is triggered by various causes such as respiratory infections (viral, bacterial or fungal), autoimmune disorders, heart surgery, etc. Pericarditis can be short durational (acute) or long durational (chronic) in onset. The patient of pericarditis experience sharp pain in the chest that may mimic pain from a heart attack. Leaning forward brings relief in pain. To understand this, one should know the signs and symptoms of the pericarditis.

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Signs and symptoms of pericarditis include:

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  • Chest pain that can be dull or sharp with a stabbing experience. This pain comes suddenly and felt on the left side of chest sometimes in the middle of same.
  • The patient may feel short of breath, mainly on lying down.
  • Fever may be present in some of the cases.
  • Cough.
  • Weakness in the whole body.
  • Palpitations.
  • Swelling in the lower extremities and stomach.
  • Reduced blood pressure.
  • Dull pain in the shoulder and back.
  • The symptoms of pericarditis may confuse the patient of a heart attack because of its resemblance to the character of pain.

What Do Patients of Pericarditis Feel Chest Pain?

Outer covering sac of the heart has two thin membranes separated by a small amount of fluid. This sac is known as pericardium. It encases the heart and keeps it in its place to work in proper manner. This fluid prevents rubbing and friction of both the membranes.

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When the infections of the chest or other causes induce infection of these membranes, more fluid is accumulated in between the membranes than the normal amount. It may also occur after a major heart attack or heart surgery probably due to irritation developed in the underlying heart muscles. This swelling of the sac is called pericarditis. This excess fluid may leak and get into the heart. The swelled membranes can rub against the heart. They may impact the normal pumping action of the heart by reducing its room to move.

Patient experiences chest pain because of this rubbing action of swelled membranes over the heart. The pain comes suddenly and may go off in a short span of time. But the pain can be sharp enough to hamper patient’s normal activities. It gets worse when the patient inhales air or lies down.

Why is the Pain of Pericarditis Relieved by Leaning Forward?

The position of the patient plays a significant role in pericardial pain. Pain gets increased when the patient lies down or coughs. The chest pain developed due to pericarditis can be relieved by leaning forward. The intensity of pain remarkably reduces when one leans forward or sits up. This position is most favorable because of following reasons-

  • The forward lean position decreases the pressure of the inflamed sac on the heart, especially during inspiration. The load on the heart reduces to a great extent.
  • The diaphragm moves downwards under the influence of the gravity in this position. The outermost membrane gets more room to adjust instead of rubbing against the innermost membrane of the pericardium.
  • Leaning forward provides more room to heart for its pumping action.
  • Leaning forward also relieves coughing.
  • Inhaling activities improve while sitting up and leaning forward as the pressure on chest wall reduces. The reason behind this is the redistribution of the fluid.
  • The organs of the abdomen are also moved downward due to gravity in this position and are prevented to exert the pressure on diaphragm relieving pericardial pain to some extent.
  • Leaning forward is also very significant for medical examination as rubbing of pericardium produces a typical sound, audible more clearly in this position.

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Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: April 18, 2018

This article does not provide medical advice. See disclaimer

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