Myopericarditis: Symptoms, Causes, Diagnosis, Treatment and Recovery
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is myopericarditis?
Myopericarditis is inflammation of both the sac around the heart and the heart muscle, with the sac affected more. Symptoms may include sharp chest pain that eases when leaning forward, breathlessness, fever and palpitations. It ranges from mild to severe, and most people have a very good prognosis. Chest pain and shortness of breath need medical assessment. [1]
What the research says
Myopericarditis generally has a good outlook. In a prospective multicenter study of 486 patients with acute pericarditis or a myopericardial inflammatory syndrome, normal left-ventricle function returned in more than 90% of those with myopericarditis or perimyocarditis after a median follow-up of 36 months. No deaths and no progression to heart failure were recorded, and recurrences (mostly recurrent pericarditis) occurred in 11% of myopericarditis and 12% of perimyocarditis cases versus 32% of acute pericarditis (Imazio et al., Circulation, 2013). [2]
Colchicine was linked to fewer recurrences in people with pericarditis plus heart-muscle involvement. In a retrospective study of 175 patients with a first attack, a propensity-matched comparison (73 patients per group) found recurrences in 19.2% of those treated with colchicine versus 43.8% of those who were not, and side effects were mild (3 patients, 1.7%). Because this was not a randomized trial, treatment decisions stay with the treating clinician (Collini et al., Heart, 2024). [3]
What is myopericarditis?
Myopericarditis affects two nearby but distinct parts of the heart. The myocardium is the heart muscle. The pericardium is the protective sac around the heart. In myopericarditis, both structures are inflamed, but the inflammation is more prominent in the pericardium. [1]
The related term myocarditis describes inflammation of the heart muscle, and pericarditis describes inflammation of the protective sac. The distinction matters because clinicians consider which part of the heart is most affected when evaluating symptoms, test results and treatment needs.
Myopericarditis vs. perimyocarditis
The terms describe a similar combination of inflammation but emphasize different areas. Myopericarditis means the pericardium is affected more than the heart muscle. Perimyocarditis means the heart muscle is affected more than the pericardium. [1]
Imaging can help clinicians evaluate how well the heart chambers are working. When the chambers are not working properly, the condition is considered perimyocarditis rather than myopericarditis. [1]
How is myopericarditis different from pericarditis?
Myopericarditis and pericarditis can cause similar symptoms, including chest pain, shortness of breath, fatigue and fever. Myopericarditis is more often associated with abnormal heart rhythms and heart-muscle dysfunction, while pericarditis is more often associated with pericardial effusion, meaning extra fluid around the heart. [1]
Symptoms alone cannot reliably distinguish these conditions. Clinicians may need an examination, blood tests, an EKG, an echocardiogram and other imaging to understand which tissues are inflamed and how the heart is functioning.
What are the symptoms of myopericarditis?
Symptoms can vary from person to person and may reflect inflammation around the heart, inflammation in the heart muscle, or both.
Possible symptom | What it may be like |
Chest pain | May be sharp, worsen with breathing in or coughing, continue without a break, or improve when leaning forward. |
Shortness of breath | A possible symptom that should be discussed with a healthcare provider. |
Heart palpitations | A feeling of an abnormal or noticeable heartbeat. |
Fever | May occur with the inflammatory illness. |
Tiredness | Fatigue or unusual tiredness may occur. |
Chest pain has many possible causes, and a symptom description cannot confirm myopericarditis. New, persistent or concerning chest symptoms should be assessed by a healthcare professional.
Why chest pain may change with breathing or posture
Pain that worsens when breathing in or coughing and improves when leaning forward is a pattern worth telling a clinician about. It does not establish the cause of chest pain by itself. [1]
What causes myopericarditis?
In many cases, healthcare providers cannot identify a definite cause. Viruses are commonly suspected, but other infections, medical conditions, cancers, radiation and some vaccines are also listed as possible causes. [1]
Possible cause or association | Examples |
Viruses | Viruses, including COVID-19. |
Bacteria | Bacteria, including tuberculosis. |
Other infections | Parasites and fungi. |
Vaccines | Smallpox or COVID-19 vaccines. Myopericarditis from a COVID-19 vaccine is rare and usually not serious. |
Hormonal or kidney conditions | Hypothyroidism and kidney failure. |
Tumors or cancer | A tumor in the heart, or cancer that has spread from another part of the body. |
Inflammatory disease | Lupus, inflammatory bowel disease or rheumatoid arthritis. |
Radiation | Radiation to the chest. |
A possible association does not mean that it caused a particular person's condition. Determining the cause is a clinical question that may depend on the person's symptoms, examination and test results.
Risk factors
Because viruses are believed to be the most common cause, having a virus is a risk factor. Herpes, influenza, COVID-19, coxsackie virus, HIV and hepatitis C are among the viral infections that can increase risk. People with myopericarditis are more likely to be male and younger than 40. [1]
These observations describe patterns in groups of people. They do not predict whether a specific person will develop myopericarditis.
What complications can myopericarditis cause?
Many people recover without long-term effects, but myopericarditis can sometimes lead to complications.
Complication | Plain-language explanation |
Constrictive pericarditis | The protective sac around the heart can become less flexible and interfere with normal heart movement. |
Heart failure | The heart may not pump as effectively. |
Reduced left-ventricle function | The left ventricle, one of the heart's chambers, may not work properly. |
Abnormal heart rhythms | Inflammation can be associated with irregular or abnormal rhythms. |
The risk of constrictive pericarditis is less than 1% when myopericarditis has a viral cause and 20% to 30% when the cause is bacterial. These are general estimates and should not be used to predict an individual's outcome. [1]
How is myopericarditis diagnosed?
A healthcare provider may suspect myopericarditis when a person has pericarditis-like symptoms, such as chest pain, together with other findings. Possible findings include pericardial effusion, signs of inflammation in blood tests, an abnormal EKG and imaging that shows the heart chambers are working properly. [1]
If imaging shows that the heart chambers are not working properly, the condition is considered perimyocarditis. The distinction is based on the relative effect on the pericardium and the heart muscle, not on symptoms alone. [1]
Tests that may be used
Test | What it may help clinicians assess |
Blood tests | Signs of inflammation and other cardiac or medical information. |
Electrocardiogram (EKG) | The heart's electrical activity and rhythm. |
Echocardiogram | Heart structure, movement and how the chambers are working. |
Heart MRI | Detailed imaging of the heart and surrounding tissues. |
Chest X-ray | The chest and heart area as part of the overall evaluation. |
Cardiac CT | Cross-sectional imaging that may add information about the heart and chest. |
No single test should be interpreted in isolation. Clinicians combine the history, examination and test results to determine the most appropriate diagnosis and care plan.
How is myopericarditis treated?
Treatment depends on the person's symptoms, test results, underlying cause and whether the pericardium or heart muscle is affected more. A clinician may recommend medicines, a procedure or hospital care.
Treatment category | Examples and context |
Anti-inflammatory medicines | Nonsteroidal anti-inflammatory drugs such as ibuprofen, and other anti-inflammatory medicines such as prednisone and colchicine. The appropriate treatment and dose depend on the clinical situation. |
Heart-failure or blood-pressure medicines | Beta blockers, ACE inhibitors or diuretics may be used when clinically appropriate. |
Fluid drainage | Pericardiocentesis drains fluid from the pericardium. |
Hospital care | A healthcare provider may admit someone to the hospital depending on the situation. |
This article does not provide doses because treatment must be individualized. Take medicines only as prescribed, and do not start, stop or change a medicine without advice from the prescribing clinician.
Possible side effects and procedure complications
Possible medicine side effects include upset stomach, dizziness, loss of appetite, fatigue, dry cough and headache. Possible complications of pericardiocentesis include infection or injury to the heart, lungs, stomach, liver or nearby major blood vessels. [1]
The potential for side effects does not mean that they will occur. Anyone with new or disruptive symptoms during treatment should contact the treating healthcare professional for guidance.
What are recovery and outlook like after myopericarditis?
The heart needs time to recover. Recovery from myopericarditis can take four to six weeks, and exertion should be avoided during that period. You may take ibuprofen for days or several weeks, depending on your situation. [1]
People who play sports or whose heart muscle was affected may be asked to limit physical activity for up to six months. The timeline is individualized, so follow the activity plan from your healthcare provider rather than using a general timeline as clearance to exercise. [1]
The prognosis is very good. Most people do not have complications or long-term effects, and myopericarditis usually does not return after treatment. [1]
Alcohol and recovery
Limit alcohol to a maximum of one drink per day. Alcohol guidance may need to be discussed with a clinician if you have other medical conditions, take medicines or are recovering from heart-muscle inflammation. [1]
What follow-up is needed after myopericarditis?
Follow-up after myopericarditis is important because clinicians may need to reassess symptoms, inflammation, heart rhythm and heart function. Visits are recommended after one month, six months and one year. Possible follow-up tests include:
The exact schedule and tests can vary with the person's condition and recovery.
How can people live well with myopericarditis?
Living with myopericarditis during recovery means following the instructions from your healthcare team. Take medicines as prescribed, attend follow-up appointments and ask when activity can safely increase. Useful questions to ask a clinician include:
Question | Why it may help |
Do you know what caused my myopericarditis? | The cause is often not definite, and understanding what is known can clarify the plan. |
How long will I need to take medication? | Treatment duration depends on the clinical situation. |
When should I start to feel better? | Recovery commonly takes several weeks, but the expected timeline is individual. |
When can I return to exercise or sport? | Activity may need to be limited while the heart recovers. |
Which symptoms should prompt a call? | Follow-up helps address new or changing symptoms and possible complications. |
When to contact a healthcare provider
Contact a healthcare provider if you have symptoms that suggest constrictive pericarditis: heart palpitations, shortness of breath, swelling in the legs and feet, retaining water or severe swelling in the belly. [1]
New, worsening or persistent chest pain, breathing difficulty or fainting should be treated as a reason to seek prompt medical assessment, because serious heart and lung conditions can present with overlapping symptoms.
Conclusion
Myopericarditis is inflammation affecting both the protective sac around the heart and the heart muscle, with the pericardium affected more than the myocardium. Symptoms may include chest pain, shortness of breath, fever, fatigue and palpitations, and clinicians may use blood tests, an EKG, echocardiography and additional imaging to evaluate the condition.
Most people have a very good outlook, but recovery takes time. Following the treatment plan, limiting exertion as advised and attending follow-up visits help the care team monitor recovery. If you are experiencing chest pain, shortness of breath or heart palpitations, contact a qualified healthcare professional for an assessment.
Frequently Asked Questions
Is myopericarditis the same as myocarditis?
No. Myocarditis means inflammation of the heart muscle. Myopericarditis affects both the heart muscle and the protective sac around the heart, with the pericardium affected more.
Is myopericarditis the same as pericarditis?
No. Pericarditis affects the protective sac around the heart. Myopericarditis affects both the sac and the heart muscle, with the sac affected more.
What is the difference between myopericarditis and perimyocarditis?
Myopericarditis means the pericardium is affected more than the heart muscle. Perimyocarditis means the heart muscle is affected more than the pericardium.
Can a virus cause myopericarditis?
Yes. Viruses are believed to be the most common cause, although a definite cause is often not found.
Can a vaccine cause myopericarditis?
Smallpox and COVID-19 vaccines are listed among possible causes. Myopericarditis related to a COVID-19 vaccine is rare and usually not serious. Anyone with concerning symptoms after vaccination should seek medical advice.
How long does myopericarditis last?
Recovery can take four to six weeks, and exertion should be avoided during that time. People who play sports or whose heart muscle was affected may be asked to limit activity for up to six months.
Is myopericarditis dangerous?
Myopericarditis can be mild to severe. Most people have a very good prognosis and do not develop long-term effects, but complications can include heart failure, abnormal heart rhythms, reduced left-ventricle function and constrictive pericarditis.
Can myopericarditis come back?
Myopericarditis usually does not return after treatment. Follow-up remains important, and new or changing symptoms should be discussed with a healthcare provider.
What tests are used for myopericarditis?
Possible tests include blood tests, an EKG, an echocardiogram, heart MRI, chest X-ray and cardiac CT.
When should I follow up after treatment?
Follow-up is recommended after one month, six months and one year. Appointments may include an echocardiogram, EKG, blood tests or cardiac MRI.
Related reading
References
Cleveland Clinic. Myopericarditis: Symptoms, Causes & Treatment. Cleveland Clinic. Last updated January 6, 2023. https://my.clevelandclinic.org/health/diseases/24579-myopericarditis
Imazio M, Brucato A, Barbieri A, et al. Good prognosis for pericarditis with and without myocardial involvement: results from a multicenter, prospective cohort study. Circulation. 2013;128(1):42-49. PMID 23709669. https://doi.org/10.1161/CIRCULATIONAHA.113.001531
Collini V, De Martino M, Andreis A, et al. Efficacy and safety of colchicine for the treatment of myopericarditis. Heart. 2024;110(10):735-739. PMID 38238076. https://doi.org/10.1136/heartjnl-2023-323484
Disclaimer
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional with any questions about a medical condition or treatment.
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