Last reviewed: 6 Nov 2021
Last updated: 15 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • chest pain
  • pericardial rub

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

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.

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