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Last reviewed: 15 Apr 2025
Last updated: 28 Sep 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • chest pain
  • pericardial rub
Full details

Other diagnostic factors

  • fever
  • myalgias
Full details

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
Full details

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
Full details

Investigations to consider

  • blood cultures
  • erythrocyte sedimentation rate
  • creatine kinase
  • autoimmune screen
  • viral screen
  • chest CT or cardiac MRI
  • pericardial biopsy
Full details

Treatment algorithm

INITIAL

suspected pericarditis

ACUTE

idiopathic or viral (non-purulent)

not idiopathic or viral (non-purulent)

purulent

ONGOING

recurrent disease

Contributors

Expert advisers

Shrilla Banerjee, MD, FRCP

Consultant Interventional Cardiologist

East Surrey Hospital

Surrey and Sussex Healthcare NHS Trust

UK

Disclosures

SB has received speaker fees for educational lectures (presentation content was her own) and meeting participation from Menarini, Edwards Lifesciences, Abbott Vascular, and Shockwave IVL. She has also participated in an Advisory Board for Sahajanand Medical Technologies Limited. SB has received travel sponsorship from Biosensors International to attend the PCR meeting in Paris in 2022. She has prepared a manuscript on coronary microvascular dysfunction for Abbott for Cardiovascular News (no royalties).

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Resham Baruah MBBS, BSc MRCP, PhD

Consultant Cardiologist

Chelsea and Westminster Hospital NHS Foundation Trust

Royal Brompton & Harefield NHS Foundation Trust

London

UK

Katherine Wu MD

Associate Professor of Medicine

Division of Cardiology

Johns Hopkins Medical Institutions

Baltimore

MD

Disclosures

RB has received honoraria/speakers’ fees from Novartis and Boehringer Ingelheim. KW declares that she has no competing interests.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015 Nov 7;36(42):2921-64.Full text  Abstract

Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of acute and recurrent pericarditis: JACC state-of-the-art review. J Am Coll Cardiol. 2020 Jan 7;75(1):76-92.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Pericarditis images
  • Differentials

    • Pulmonary embolism
    • Myocardial infarction or ischaemia
    • Pneumonia
    More Differentials
  • Guidelines

    • 2015 ESC guidelines for the diagnosis and management of pericardial diseases
    • Clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease
    More Guidelines
  • Patient information

    Pericarditis

    More Patient information
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