Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- chest pain
- pericardial rub
Other diagnostic factors
- fever
- myalgias
Risk factors
- male sex
- age 20 to 50 years
- transmural myocardial infarction
- cardiac surgery
- neoplasm
- viral and bacterial infections
- uraemia or on dialysis
- systemic autoimmune disorders
- pericardial injury
- mediastinal radiation
Diagnostic investigations
1st investigations to order
- ECG
- serum troponin
- pericardiocentesis
- C-reactive protein
- serum urea and electrolytes
- full blood count
- liver function tests
- chest x-ray
- echocardiography
Investigations to consider
- blood cultures
- erythrocyte sedimentation rate
- creatine kinase
- autoimmune screen
- viral screen
- chest CT or cardiac MRI
- pericardial biopsy
Treatment algorithm
suspected pericarditis
idiopathic or viral (non-purulent)
not idiopathic or viral (non-purulent)
purulent
recurrent disease
Contributors
Expert advisers
Resham Baruah, MBBS, BSc MRCP, PhD
Consultant Cardiologist
Chelsea and Westminster Hospital NHS Foundation Trust
Royal Brompton & Harefield NHS Foundation Trust
London
UK
Biography
RB is specialist advisor to the 2018 NICE guideline on chronic heart failure in adults and is a member of the European Heart Failure Association Task Force on palliative care in heart failure.
Disclosures
RB has received honoraria/speakers’ fees from Novartis and Boehringer Ingelheim.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Katherine Wu MD
Associate Professor of Medicine
Division of Cardiology
Johns Hopkins Medical Institutions
Baltimore
MD
Peer reviewers
Laura Dobson, MBChB, MD
Consultant Cardiologist
Wythenshawe Hospital
Manchester University Foundation Trust
Manchester
UK
Disclosures
LD declares that she has no competing interests.
Editors
Annabel Sidwell
Section Editor, BMJ Best Practice
Disclosures
AS declares that she has no competing interests.
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Differentials
- Pulmonary embolism
- Myocardial infarction or ischaemia
- Pneumonia
More DifferentialsGuidelines
- 2015 ESC guidelines for the diagnosis and management of pericardial diseases
- Clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease
More GuidelinesPatient leaflets
Pericarditis
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