Pericarditis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 26 Jan 2026

Last updated: 22 Jan 2026

Pericarditis 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 may be present.

Diagnostic signs include widespread electrocardiographic ST elevation or PR depression and a new or worsening pericardial effusion on echocardiography; blood tests generally suggest systemic inflammation.

Treatment is directed at any underlying systemic disorder. Idiopathic or viral pericarditis responds to nonsteroidal anti-inflammatory drugs and colchicine.

Complications include chronic recurrent pericarditis, cardiac tamponade, and constrictive pericarditis.

Definição

Pericarditis is an inflammation of the pericardium. The acute form is defined as new-onset inflammation lasting <4-6 weeks. It is characterized clinically by a triad of chest pain, pericardial friction rub, and serial electrocardiographic changes. A pericardial effusion may or may not be present. Pericarditis is the most common disease of the pericardium encountered in clinical practice.[1]

História e exame físico

Principais fatores diagnósticos

chest pain
pericardial rub

Detalhes completos

Outros fatores diagnósticos

fever
myalgias
signs of right-sided heart failure

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

chest CT or cardiac MRI
pericardiocentesis/biopsy

Detalhes completos

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

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

Disclosures

SD declares that she has no competing interests.

Shrilla Banerjee, MBMD, MRCP

Consultant Cardiologist

East Surrey Hospital

Surrey and Sussex NHS Trust

Redhill

Disclosures

SB declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

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

Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021 Nov 30;144(22):e368-e454.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.

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
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Pericarditis
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Pericarditis

Summary

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Treatment algorithm

suspected pericarditis

purulent

non-purulent

recurrent disease

Contributors

Expert advisers

Antonio Abbate, MD, PhD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Susan Denfield, MD

Disclosures

Shrilla Banerjee, MBMD, MRCP

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

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

Differentials

Guidelines

Videos

პაციენტის ბროშურები

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

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