Acute pericarditis is a clinical diagnosis.
Symptoms include sharp, severe retrosternal chest pain worse with inspiration and a supine position.
The classic physical finding is a pericardial friction rub. A low-grade fever is often present.
Diagnostic signs include new widespread diffuse concave upwards ST elevation and/or PR depression on ECG and new or worsening pericardial effusion on echocardiography; blood tests generally suggest systemic inflammation.
Cardiac tamponade is a life-threatening complication of acute pericarditis. These patients require urgent pericardiocentesis.
All patients should be given a non-steroidal anti-inflammatory drug as first-line treatment. Colchicine should also be given, unless the patient has tuberculous pericarditis.
Further treatment is directed at any underlying systemic disorder.
Complications include chronic recurrent pericarditis, cardiac tamponade, and constrictive pericarditis.
Pericarditis is an inflammation of the pericardium. The acute form is defined as new-onset inflammation lasting <4 to 6 weeks. It can be either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate. It is characterised clinically by a triad of chest pain, pericardial friction rub, and serial electrocardiographic changes. Constrictive pericarditis impedes normal diastolic filling and can be a medium to late complication of acute pericarditis. Pericarditis is the most common disease of the pericardium encountered in clinical practice.
This topic covers both acute and recurrent pericarditis in adults. Children are not covered in this topic.
History and exam
Key diagnostic factors
- presence of risk factors
- chest pain
- pericardial rub
Other diagnostic factors
- male sex
- age 20 to 50 years
- transmural myocardial infarction
- cardiac surgery
- viral and bacterial infections
- uraemia or on dialysis
- systemic autoimmune disorders
- pericardial injury
- mediastinal radiation
1st investigations to order
- serum troponin
- C-reactive protein
- serum urea and electrolytes
- full blood count
- liver function tests
- chest x-ray
Investigations to consider
- blood cultures
- erythrocyte sedimentation rate
- creatine kinase
- autoimmune screen
- viral screen
- chest CT or cardiac MRI
- pericardial biopsy
idiopathic or viral (non-purulent)
not idiopathic or viral (non-purulent)
Resham Baruah, MBBS, BSc MRCP, PhD
Chelsea and Westminster Hospital NHS Foundation Trust
Royal Brompton & Harefield NHS Foundation Trust
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.
RB has received honoraria/speakers’ fees from Novartis and Boehringer Ingelheim.
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
Laura Dobson, MBChB, MD
Manchester University Foundation Trust
LD declares that she has no competing interests.
Section Editor, BMJ Best Practice
AS declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
TAO declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
- Pulmonary embolism
- Myocardial infarction or ischaemia
- 2015 ESC guidelines for the diagnosis and management of pericardial diseases
- Clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease
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