Table of contents
Expand All Topics
Acute pericarditis
Background
Overview
Definition
Acute pericarditis is a disease characterized by acute inflammation of the pericardium.
1
Pathophysiology
Most cases of acute pericarditis are idiopathic (80-90%) and assumed to be due to viral infection. Other important causes include post-cardiac injury syndromes, connective tissue diseases (such as SLE), and cancer.
2
Epidemiology
In the US, the incidence of acute pericarditis requiring hospitalization is estimated at 26 cases per 100,000 person-years.
3
Disease course
Inflammation of the pericardium results in the formation of a pericardial effusion, which may progress to cardiac tamponade and obstructive shock.
2
Prognosis and risk of recurrence
Acute pericarditis is associated with 5.7% all-cause mortality at 30 days, and 17.3% all-cause mortality at 1 year.
3
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of acute pericarditis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the European Society for Microbiology and Infectious Diseases (ESCMID 2022), the European Society of Cardiology (ESC/ESTRO/EHA/IC-OS 2022), the Infectious Diseases Society of America (IDSA/ACR/AAN 2021), the Society of Cardiovascular Computed ...
Show more
Screening and diagnosis
Diagnostic criteria: as per EACTS/ESC 2015 guidelines, make a clinical diagnosis of acute pericarditis in patients with ≥ 2 out of 4 suggestive clinical criteria (chest pain, pericardial rub, ECG changes, and pericardial effusion).
⁄
Diagnostic criteria for acute pericarditis
Characteristic symptoms of chest pain (typically sharp and pleuritic, improved by sitting up and leaning forward)
Pericardial friction rub (a superficial scratchy or squeaking sound best heard with the diaphragm of the stethoscope over the left sternal border)
Typical ECG changes (new diffuse ST segment elevation or PR depression in acute phase)
Pericardial effusion identified on diagnostic imaging (such as echocardiogram or CT)
Acute pericarditis is unlikely
Diagnostic investigations
Initial evaluation: as per AAFP 2024 guidelines, obtain the following in the initial evaluation for acute pericarditis:
history and physical examination
ECG
CXR
TTE
baseline laboratory tests.
B
More topics in this section
TTE
Cardiac MRI/CT
Evaluation for viral pericarditis
Diagnostic procedures
Coronary angiography: as per EACTS/ESC 2015 guidelines, perform coronary angiography (according to clinical presentation and risk factor assessment) to rule out acute coronary syndromes in patients with pericarditis and suspected myocarditis.
B
More topics in this section
Diagnostic pericardiocentesis
Pericardial biopsy
Medical management
Setting of care: as per AAFP 2024 guidelines, admit patients with acute pericarditis having risk factors for serious disease or complications to the hospital for further treatment and etiologic workup.
B
More topics in this section
General principles
NSAIDs
Colchicine
Corticosteroids
Management of recurrent pericarditis
Nonpharmacologic interventions
Specific circumstances
Pediatric patients: as per EACTS/ESC 2015 guidelines, administer NSAIDs at high doses as first-line therapy for acute pericarditis in pediatric patients until complete symptom resolution.
B
Show 4 more
More topics in this section
Patients with purulent pericarditis
Patients with uremic pericarditis
Patients with post-cardiac injury syndromes
Patients with radiation pericarditis
Patients chemotherapy-induced pericarditis
Patients with neoplastic pericardial disease
Patients with SLE
Patients with relapsing polychondritis
Patients with polyarteritis nodosa
Patients with Lyme disease
Patients with Chagas disease
Patients with lightning injury
Patients with long COVID
Patients with AIS
Patients with tuberculous pericarditis
Follow-up and surveillance
Follow-up
As per EACTS/ESC 2015 guidelines:
Schedule follow-up 1 week after treatment initiation to assess response to anti-inflammatory therapy.
B
Consider obtaining echocardiography every 6-12 months after post-cardiac injury pericarditis to exclude possible evolution toward constrictive pericarditis.
C