Pericarditis

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 6 Feb 2025
Last updated: 06 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • pericardial rub
Full details

Other diagnostic factors

  • fever
  • myalgias
  • signs of right-sided heart failure
Full details

Risk factors

  • male sex
  • age 20 to 50 years
  • transmural myocardial infarction (MI)
  • cardiac surgery
  • neoplasm
  • viral and bacterial infections
  • uremia or on dialysis
  • systemic autoimmune disorders
  • pericardial injury
  • mediastinal radiation
Full details

Diagnostic tests

1st tests to order

  • ECG
  • serum troponin
  • pericardial fluid/blood culture
  • erythrocyte sedimentation rate (ESR)
  • CRP
  • serum BUN
  • CBC
  • chest x-ray
  • echocardiography
Full details

Tests to consider

  • chest CT or cardiac MRI
  • pericardiocentesis/biopsy
Full details

Treatment algorithm

INITIAL

suspected pericarditis

ACUTE

purulent

non-purulent

ONGOING

recurrent disease

Contributors

Expert advisers

Antonio Abbate, MD, PhD

Professor of Cardiology

Division of Cardiovascular Medicine

University of Virginia

Charlottesville

VA

Disclosures

AA has received grant support and consultant fees from Applied Clinical Intel, Astra Zeneca, Cromos Pharma, Eli Lilly, Implicit Biosciences, Janssen, Kiniksa, Merck, Novartis, Novo Nordisk, Olatec, R-Pharm, and Serpin Pharma.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge Dr Katherine Wu MD, a previous contributor to this topic.

Disclosures

KW declares that she has no competing interests.

Peer reviewers

Susan Denfield, MD

Associate Professor of Pediatrics

Division of Pediatric Cardiology

Texas Children's Hospital

Houston

TX

Disclosures

SD declares that she has no competing interests.

Shrilla Banerjee, MBMD, MRCP

Consultant Cardiologist

East Surrey Hospital

Surrey and Sussex NHS Trust

Redhill

UK

Disclosures

SB declares that she has no competing interests.

  • Pericarditis images
  • Differentials

    • Pulmonary embolism (PE)
    • Myocardial infarction or ischemia
    • Pneumonia
    More Differentials
  • Guidelines

    • 2025 ACC/AHA/ACEP/NAEMSP/SCAI guideline for the management of patients with acute coronary syndromes
    • 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain
    More Guidelines
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    How to perform an ECG: animated demonstration

    More videos
  • Patient information

    Pericarditis

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer