Materiały źródłowe

• #1 Diagnosis of acute pericarditis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis

  Acute pericarditis, the most common pericardial syndrome in clinical practice, is diagnosed based on two of the following criteria: a) chest pain b) pericardial friction-rub c) characteristic ECG changes (new widespread ST-elevation or PR depression) d) pericardial effusion. […] The diagnosis is clinical and can be made based on two of the following criteria: a) pericardial chest pain in the patients medical history b) pericardial rubs upon auscultation c) new widespread ST-elevation or PR depression on ECG d) pericardial effusion (new or worsening). […] Supportive findings are elevation of inflammatory markers and evidence of pericardial inflammation by computed tomography (CT) or cardiac magnetic resonance (CMR). […] The main diagnostic evaluation consists of medical history (recent viral infection) and physical examination (to detect pericardial rubs at auscultation and additional possible signs of a systemic disease that may be responsible for pericarditis); blood tests (WBCs, ESR, CRP, troponin, complete blood count [CBC], urea, creatinine); ECG; transthoracic echocardiography (TTE); and chest X-ray.

• #1 Pericarditis: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17353-pericarditis

  Sharp pain in your chest and back of the shoulders that feel better when you sit up and lean forward, and chest pain with breathing are two major clues that you may have pericarditis and not a heart attack. […] Your healthcare provider will talk to you about your symptoms and medical history (such as whether you’ve recently been sick) and review your history of heart conditions, surgery and other health problems that could put you at a higher risk of pericarditis. […] Healthcare providers use a variety of ways to check for pericarditis and any complications, such as pericardial effusion or constrictive pericarditis. You may need one or more tests, such as: […] Blood tests can help your provider make sure you’re not having a heart attack, see how well your heart is working, test the fluid in the pericardium and help find the cause of pericarditis.

• #1 Pericarditis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pericarditis/diagnosis-treatment/drc-20352514

  To diagnose pericarditis, a healthcare professional examines you and asks questions about your symptoms and medical history. […] The care professional listens to your heart using a device called a stethoscope. Pericarditis causes a specific sound, called a pericardial rub. The noise occurs when the two layers of the sac surrounding the heart, called the pericardium, rub against each other. […] Tests to diagnose pericarditis or rule out conditions that may cause similar symptoms may include: Blood tests usually are done to check for signs of a heart attack, inflammation and infection. […] An electrocardiogram is a quick and painless test that records the electrical signals in the heart. […] A chest X-ray can show changes in the size and shape of the heart. […] An echocardiogram shows how well the heart is pumping blood. […] Cardiac CT scans use X-rays to create images of the heart and chest. […] This test uses magnetic fields and radio waves to create detailed images of the heart.

• #1 How is Acute Pericarditis Diagnosed and Treated? – The Hospitalist

  https://www.the-hospitalist.org/hospitalist/article/125026/how-acute-pericarditis-diagnosed-and-treated/

  Acute pericarditis is a clinical diagnosis. […] Pericarditis primarily is a clinical diagnosis. Most patients present with chest pain. […] Acute pericarditis is a clinical diagnosis supported by EKG and echocardiogram. At least two of the following four criteria must be present for the diagnosis: pleuritic chest pain, pericardial rub, diffuse ST-segment elevation on EKG, and pericardial effusion. […] A pericardial friction rub is nearly 100% specific for a pericarditis diagnosis, but sensitivity can vary (16% to 85%) depending on the frequency of auscultation and underlying etiology.

• #1 Acute pericarditis – EMCrit Project

  https://emcrit.org/ibcc/pericarditis/

  Troponin is frequently elevated (with sensitivity depending on the assay). […] Troponin elevation is disproportionately low, as compared to MI. […] Elevated troponin may imply a certain degree of myopericarditis (rather than purely pericarditis). […] CRP elevation has a sensitivity of ~80%, but such elevations are often minimal (often utilizing a cutoff value of 3 mg/L). […] Higher CRP levels may predict a greater risk of recurrence. […] Serial measurement of CRP may help monitor disease activity over time. […] Echocardiography is generally recommended. […] Ventricular dysfunction raises the possibility of perimyocarditis. […] Most patients will not require pericardiocentesis. […] Suspected bacterial, tuberculous, or neoplastic pericarditis (and effusion is large enough to access safely).

• #1 Diagnosing Pericarditis | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/1101/p1695.html

  Pericarditis, or inflammation of the pericardium, is most often caused by viral infection. […] Chest radiographs, Doppler studies, and laboratory tests confirm the diagnosis and provide information about the degree of effusion. […] The diagnosis of pericarditis and its complications requires a high index of suspicion. Clinical features and the probability of a cause of pericarditis may assist in recognition. Potential confirmatory studies include the electrocardiogram (ECG), the chest radiograph, Doppler studies, and selected laboratory tests. […] In acute pericarditis, the ECG typically shows ST-segment elevation in all leads, with an upward concavity of the elevation (so-called smiling face). […] If more than 250 mL of fluid has accumulated, the cardiac silhouette is usually enlarged on the chest radiograph. […] The diagnostic test of choice for large effusions, cardiac tamponade, and constrictive pericarditis is two-dimensional Doppler echocardiography. […] Laboratory studies are useful for excluding other possible causes of symptoms and clarifying the underlying cause of pericarditis.

• #1 Pericarditis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericarditis-diagnosis/

  […] […] ECG […] There are four stages of ECG evolution in pericarditis, all of which are found in 60% of cases (figure 1). […] Stage 1 (hours to days): Diffuse ST elevation and PR depression, ST depression in aVR only […] Stage 2 (within first week): ST and PR segments normalize […] Stage 3: Diffuse T wave inversion and ECG otherwise normal […] Stage 4: T waves return to normal (May have indefinite persistence of T wave inversion) […] […] […] Imaging […] CXR typically normal […] Large pericardial effusion is uncommon – cardiomegaly. […] Transthoracic echocardiography […] Pericardial effusion in up to 60% of cases, often mild. […] Wall motion abnormalities suggest ACS rather than pericarditis.

• #1 Pericarditis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericarditis-diagnosis/

  Pericarditis – Diagnosis […] Diagnosis of acute pericarditis requires at least two of the four main clinical criteria: […] Typical chest pain (> 85% cases). […] Pericardial friction rub (up to 30% cases). […] New widespread ST elevation or PR depression (up to 60% cases). […] Pericardial effusion (up to 60% cases). […] Supportive findings for diagnosis include: elevated inflammatory markers, evidence of pericardial inflammation through CT or CMR (not an ED issue). […] Diagnostic pericardiocentesis may be considered by cardiology, internal medicine. […] […] […] Pericarditis features that differentiate it from ACS: […] ST elevation is ‘concave’ up but typically ‘convex’ up in ACS (figure 2) […] Down sloping T-P segments (“Spodick sign”) […] Absence of pathologic Q waves

• #1 Pericarditis ECG Changes • LITFL • ECG Library Diagnosis

  https://litfl.com/pericarditis-ecg-library/

  TTE is useful in the early assessment of patients with suspected pericarditis to look for complications such as large pericardial effusion and cardiac tamponade […] Pericarditis is classically associated with ECG changes that evolve through four stages. […] Less than 50% of patients progress through all four classical stages and evolution of changes may not follow this typical pattern. […] PR segment depression is only reliably seen in viral pericarditis, not by other causes. It is often only an early transient phenomenon (lasting only hours). […] Get serial ECGs on any patient with chest pain.

• #1 Acute Pericarditis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p553.html

  Transthoracic echocardiography should be performed to exclude a pericardial effusion and cardiac tamponade. […] The absence of a pericardial effusion does not exclude acute pericarditis. […] Clinical presentation should dictate other testing and imaging to determine the etiology of the pericarditis.

• #1 Chronic Pericarditis – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/pericardial-disease-and-myocarditis/chronic-pericarditis

  Magnetic resonance imaging (MRI) or computed tomography (CT) can be used to determine the thickness of the pericardium. Normally, the pericardium is less than 1/8 inch (3 millimeters) thick, but in chronic constrictive pericarditis, it is usually about one fifth of an inch (5 millimeters) thick or more. […] A biopsy may be done to help determine the cause of chronic pericarditis for example, tuberculosis. A small sample of the pericardium is removed during exploratory surgery and examined under a microscope. Alternatively, a sample can be removed using a pericardioscope (a fiberoptic tube used to view the pericardium and to obtain tissue samples) inserted through an incision in the chest. […] Laboratory tests on samples of blood and fluid from the pericardium may also be needed to help determine the cause of pericarditis.

• #1 Acute pericarditis: Update on diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6964178/

  Diagnosis of acute pericarditis requires the presence of any two of: pericarditic chest pain; pericardial rub; saddle-shaped ST-elevation and/or PR-depression; non-trivial new or worsening pericardial effusion. […] Inpatient investigation and more intensive evaluation for a non-viral aetiology should be considered where there is any fever 38C; gradual onset; large effusion (20 mm) or tamponade; lack of response to 1 week of non-steroidal anti-inflammatory drugs or where there is any history of trauma, immunosuppression/deficiency or oral anticoagulant use. […] Diagnosis of pericarditis requires the presence of two of typical pericardial chest pain; pericardial friction rub; widespread ST-elevation and/or PR-depression; and a new or increasing non-trivial pericardial effusion. […] If diagnostic uncertainty remains, cardiovascular magnetic resonance with T2-weighted and late gadolinium enhancement imaging can be helpful for confirming the presence of any pericardial inflammation, and excluding concomitant myocarditis as well as other differentials.

• #1 New Diagnostic Criteria for Acute Pericarditis: A Cardiac MRI Perspective

  https://www.acc.org/Latest-in-Cardiology/Articles/2015/11/05/11/08/New-Diagnostic-Criteria-for-Acute-Pericarditis

  Overall, 18 of 44 patients (41%) would not have met current criteria for a diagnosis of pericarditis, if not for CMR findings. […] These data suggest that a substantial portion of patients with chest pain have pericarditis detectable by CMR imaging, but not by currently accepted diagnostic criteria. […] Although cardiac MRI appears to be useful in detecting pericardial inflammation, the imaging studies have not had direct confirmation with histologic data. […] Until cardiac MRI detection is fully validated, the practical value of cardiac MRI imaging in patients with suspected pericarditis is its ability to detect pericardial effusion, which is often missed with trans-thoracic 2-D echocardiography. […] A CMR study could be quickly and easily done while a patient is in the Emergency Department, and potentially save an unnecessary admission for recurrent chest pain.

• #1 Acute Pericarditis Workup: Approach Considerations, Routine Laboratory Studies, Chest Radiography

  https://emedicine.medscape.com/article/156951-workup

  Obtain electrocardiography (ECG), transthoracic echocardiography (TTE), and/or chest radiography in all individuals with suspected acute pericarditis. […] Evaluate markers of inflammation (ie, C-reactive protein [CRP]) and myocardial injury (ie, creatine kinase [CK], troponin) when acute pericarditis is suspected. […] Obtain TTE in all patients with suspected pericardial effusion (class I). […] Obtain chest radiography in patients with suspected pericardial effusion or pleuropulmonary involvement (class I). […] Evaluate markers of inflammation (ie, CRP) in patients with suspected pericardial effusion (class I). […] Obtain echocardiography as the first imaging modality for suspected cardiac tamponade to evaluate the size, location, and degree of hemodynamic impact of the pericardial effusion.

• #1 Acute Pericarditis Workup: Approach Considerations, Routine Laboratory Studies, Chest Radiography

  https://emedicine.medscape.com/article/156951-workup

  Perform urgent pericardiocentesis (or cardiac surgery) for cardiac tamponade. […] For a definitive diagnosis of viral pericarditis, perform a comprehensive workup comprising histologic, cytologic, immunohistologic, and molecular studies in pericardial fluid; consider peri-/epicardial biopsies (class IIa). […] Perform urgent pericardiocentesis for the diagnosis of purulent pericarditis Send pericardial fluid for bacterial, fungal, and tuberculous studies, and draw blood for cultures. […] The initial evaluation includes a clinical history and physical examination; ECG; chest radiography, echocardiography, CT scanning, CMRI, positron-emission tomography (PET) scanning, or PET/CT scanning, as indicated; and initial laboratory work. […] Pericardiocentesis should be performed on all patients with cardiac tamponade or suspected purulent pericarditis. […] The pericardial fluid should be analyzed for red blood cells (RBCs), total protein level, LDH level, adenosine deaminase activity, and culture (ordinary and Loewenstein media).

• #1 Pericarditis – Core EM

  https://coreem.net/core/pericarditis/

  Definition: Inflammation of the partial and/or visceral layers of the pericardium surrounding the heart. The inflammation is characterized by lymphocytes and granulocytes infiltrating the pericardium. […] Diagnosis […] Diagnostic Criteria (2 out of 4 required) […] Classic chest pain history: sharp, pleuritic and positional with radiation to the trapezius ridge […] Pericardial friction rub […] Pericardial effusion on echocardiogram […] Characteristic EKG findings […] EKG is a reliable diagnostic tool. However, EKG changes occur in stages over time and classic findings may not be present depending on the duration of symptoms […] The first step in diagnosis of pericarditis should be to think about and eliminate STEMI as the diagnosis […] No lab test has a high enough sensitivity or specificity to either rule-in or rule-out pericarditis or differentiate it from MI

• #1 Acute Pericarditis: A Diagnosis of Exclusion – ACEP Now

  https://www.acepnow.com/article/acute-pericarditis-a-diagnosis-of-exclusion/?singlepage=1

  While pericarditis is an unusual diagnosis, with an annual incidence of 27.7 per 100,000 persons, the recurrence rate of almost 30 percent is surprisingly high. […] The good news is that timely diagnosis and appropriate treatment options have been shown to decrease recurrence rates and help prevent chronic complications. […] However, considering that the clinical presentation, electrocardiogram (ECG), and laboratory findings may be confused with more deadly causes of chest pain such as myocardial infarction (MI), aortic dissection, and pulmonary embolism, pericarditis should be considered a diagnosis of exclusion in the ED. […] Despite these distinguishing features, however, there is no group of clinical features with sufficient specificity to rule in pericarditis with certainty, underlining the concept that it should be considered a diagnosis of exclusion.

• #1 Pathophysiology and Diagnosis of Constrictive Pericarditis

  https://www.acc.org/latest-in-cardiology/articles/2017/03/13/15/10/pathophysiology-and-diagnosis-of-constrictive-pericarditis

  Constrictive pericarditis (CP) is a relatively uncommon form of clinical heart failure. The true population prevalence is unknown, but amongst those with viral pericarditis it has been estimated to occur in less than 0.5% of cases. However, because it is potentially reversible, the diagnosis must not be missed. Surgical pericardiectomy has the ability to „cure” CP, with dramatic improvements in symptoms and quality of life. […] The low prevalence of CP makes identifying key physical examination and historical features an important initial step in the diagnostic process. A history of cardiac surgery, radiation or tuberculosis should heighten clinical suspicion in the presence of edema, abdominal distention and exertional dyspnea. Elevated jugular venous pressure (JVP) is present in virtually all patients that are not hypovolemic.

• #1 Purulent pericarditis: A rare diagnosis | Revista Portuguesa de Cardiologia (English edition)

  https://revportcardiol.org/en-purulent-pericarditis-a-rare-diagnosis-articulo-S2174204913001748

  The authors present two cases of purulent pericarditis secondary to pneumococcus pneumonia, a rare entity in the antibiotic era, one of them in an apparently healthy person. […] A systematized diagnostic approach to moderate pericardial effusion is presented, together with a review of purulent pericarditis. […] The presence of pericardial effusion with persistent fever with or without known etiology, particularly in the immunocompromised but also in the apparently healthy patient, should always raise the possibility of purulent pericarditis. […] A systematic approach to PE involves three stages: confirmation by TTE; assessment of hemodynamic repercussions; and determination of etiology. […] Pericardiocentesis has limited diagnostic value (6% of cases) in acute pericarditis. […] Purulent pericarditis is defined as an infection in the pericardial space that produces macroscopically or microscopically purulent fluid.

• #1 Purulent pericarditis: A rare diagnosis | Revista Portuguesa de Cardiologia (English edition)

  https://revportcardiol.org/en-purulent-pericarditis-a-rare-diagnosis-articulo-S2174204913001748

  The diagnosis can only be confirmed by pericardiocentesis (which in such cases in therapeutic) by means of macroscopic examination of the fluid, which has the biochemical characteristics of an exudate and should be subjected to microscopic study, direct and in culture, to screen for bacteria, fungi and AARB. […] Treatment must include drainage of the pericardial space, combined with systemic antibiotic therapy, initially empirical and then adjusted according to the results of microbiological study. […] Without drainage of the pericardial space, purulent pericarditis leads inexorably to death. […] Mortality in patients who are promptly diagnosed and appropriately treated is 40%, generally due to cardiac tamponade, septic shock or constriction. […] Prompt diagnosis of purulent pericarditis and initiation of appropriate treatment are the mainstays of successful management of this rare but potentially lethal entity.

• #1 Recurrent Pericarditis | American Heart Association

  https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis/recurrent-pericarditis

  Recurrent pericarditis is when you develop pericarditis for a second time after having no symptoms for at least four weeks. […] If your doctor believes you may have pericarditis, they’ll listen to your heart for rubbing sounds that often occur in people with the condition. One or more of the following tests may be used to confirm the diagnosis: […] Blood test: May reveal elevations in the white blood cell count, erythrocyte sedimentation rate, and serum C-reactive protein concentration and other signs of inflammation. […] EKG (electrocardiogram): Measures your heart’s electrical activity and certain results may suggest pericarditis. […] Chest X-ray: Takes pictures of the heart, lungs and blood vessels inside your chest. An X-ray can show whether the heart is enlarged due to excess fluid in the pericardium.

• #1 Pericarditis

  https://elsevier.health/en-US/preview/pericarditis

  Although use of corticosteroids can provide rapid symptom relief in certain patients with acute and recurrent pericarditis, their use should be avoided as they can lead to chronic disease, increased recurrence, and adverse effects. […] For patients with recurrent idiopathic pericarditis and symptom-free periods between episodes, it is unnecessary to perform a new search of disease cause with each recurrence unless new symptoms present. […] Initial workup for all patients with suspected pericarditis includes the following: ECG, chest radiography, laboratory studies, transthoracic echocardiography. […] Pericarditis secondary to malignancy, pericarditis associated with autoimmune disease, tuberculous pericarditis. […] Cardiac catheterization can be used to diagnose constrictive pericarditis when other diagnostic methods are inconclusive.

• #2 Acute pericarditis: Update on diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6964178/

  Diagnosis of acute pericarditis requires the presence of any two of: pericarditic chest pain; pericardial rub; saddle-shaped ST-elevation and/or PR-depression; non-trivial new or worsening pericardial effusion. […] Inpatient investigation and more intensive evaluation for a non-viral aetiology should be considered where there is any fever 38C; gradual onset; large effusion (20 mm) or tamponade; lack of response to 1 week of non-steroidal anti-inflammatory drugs or where there is any history of trauma, immunosuppression/deficiency or oral anticoagulant use. […] Diagnosis of pericarditis requires the presence of two of typical pericardial chest pain; pericardial friction rub; widespread ST-elevation and/or PR-depression; and a new or increasing non-trivial pericardial effusion. […] If diagnostic uncertainty remains, cardiovascular magnetic resonance with T2-weighted and late gadolinium enhancement imaging can be helpful for confirming the presence of any pericardial inflammation, and excluding concomitant myocarditis as well as other differentials.

• #2 Pericarditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431080/

  Pericarditis, the most common pathological condition affecting the pericardium, involves the inflammation of the pericardial sac surrounding the heart. […] Diagnostic evaluation typically includes an electrocardiogram, echocardiogram, and chest x-ray, with additional laboratory tests to identify underlying causes. Understanding the nuances of pericarditis is crucial for effective diagnosis and management, especially given its potential for serious complications. […] Clinically, acute pericarditis is indicated by a characteristic description of chest pain and the presence of a pericardial friction rub upon auscultation. However, laboratory studies, ECG, and echocardiography are often necessary to confirm the diagnosis. According to the 2015 ESC guidelines, a diagnosis of acute pericarditis requires the presence of at least 2 out of 4 criteria, as mentioned below.

• #2 Pericarditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431080/

  Supporting findings may include elevated inflammatory biomarkers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and leukocytosis) and evidence of pericardial inflammation on advanced imaging, such as cardiac computed tomography (CT) and cardiovascular magnetic resonance imaging (MRI). […] All patients with suspected acute pericarditis should undergo an ECG, echocardiogram, and chest x-ray. Myocardial inflammatory and injury markers, such as ESR, CRP, and troponins, should also be measured. […] Most patients will have idiopathic acute pericarditis, which can be safely managed on an outpatient basis with medical therapy alone. […] Patients exhibiting markers of poor prognosis or those who do not respond to therapy within 1 week should be admitted for further evaluation.

• #2 Symptoms and Diagnosis of Pericarditis | American Stroke Association

  https://www.stroke.org/en/health-topics/pericarditis/symptoms-and-diagnosis-of-pericarditis

  A health care professional diagnoses pericarditis based on your medical history, a physical exam and test results. […] Primary care doctors, such as a family doctor, internist or pediatrician, often diagnose and treat pericarditis. A cardiologist, pediatric cardiologist or infectious disease specialist may be involved, depending on the patient’s age and medical conditions. […] When the pericardium is inflamed, the fluid between the sac’s two layers of tissue increases. So, your health care professional will look for signs of excess fluid in your chest. A common sign is the pericardial rub. This is detected more often in patients with acute pericarditis than in those with chronic pericarditis. It’s thought that the rub might be the result of inflammation. Your health care professional will listen for this using a stethoscope.

• #2 Pericarditis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericarditis-diagnosis/

  Absence of reciprocal ST changes […] Absence of QRS widening and QT prolongation in leads with ST elevation […] […] […] Laboratory Findings […] WBC, CRP and ESR are likely to be elevated. […] Troponin may be elevated in 30% – concomitant myocarditis. […] […] […] Clinical Presentation […] History […] Quick onset, sharp chest pain: […] Pleuritic – worse on inspiration […] Improves with sitting and leaning forward […] May radiate to neck, back, shoulder and/or jaw […] May be preceded by a gastrointestinal or “flu-like” syndrome. […] Physical Examination […] Tachycardic, tachypneic, fever […] Friction rub highly specific but only present in 30% of cases […] Can fluctuate hourly. […] Heard best at end expiration, with the patient leaning forward.

• #2 Pericarditis: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17353-pericarditis

  Sharp pain in your chest and back of the shoulders that feel better when you sit up and lean forward, and chest pain with breathing are two major clues that you may have pericarditis and not a heart attack. […] Your healthcare provider will talk to you about your symptoms and medical history (such as whether you’ve recently been sick) and review your history of heart conditions, surgery and other health problems that could put you at a higher risk of pericarditis. […] Healthcare providers use a variety of ways to check for pericarditis and any complications, such as pericardial effusion or constrictive pericarditis. You may need one or more tests, such as: […] Blood tests can help your provider make sure you’re not having a heart attack, see how well your heart is working, test the fluid in the pericardium and help find the cause of pericarditis.

• #2 Management of acute pericarditis: treatment and follow-up

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Management-of-acute-pericarditis-treatment-and-follow-up

  Acute pericarditis is a self-limiting disease without significant complications or recurrences in 70% to 90% of patients. If the laboratory data support the clinical diagnosis, symptomatic treatment with aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) with gastroprotection should be initiated. Colchicine is recommended first-line therapy as an adjunct to aspirin/NSAIDs. Serum CRP guides the treatment length and response to therapy. […] The initial evaluation should be focused on screening for specific risk factors that would alter the appropriate treatment. […] Any clinical presentation that may suggest an underlying aetiology (e.g. a systemic inflammatory disease) or with at least one predictor of poor prognosis (major or minor risk factors) warrants hospital admission and an aetiology search. Patients without signs and symptoms of systemic inflammatory disease can be managed as outpatients with empiric anti-inflammatories and short-term follow-up after one week to assess the response to treatment.

• #2 Pericarditis: symptoms, diagnosis, treatment | ClinCaseQuest

  https://clincasequest.hospital/pericarditis/

  The diagnosis is clinical and can be made based on two of the following criteria: […] Pericarditis, acute pericarditis, pericardial disease, pericarditis diagnostics, Pericarditis diagnostic criteria, pericarditis treatment […] In the management of pericardial syndromes, a major controversy is the role of an extensive aetiological search and admission for all patients with pericarditis or pericardial effusion. […] According to the 2015 ESC guidelines on pericardial disease, the definite diagnosis of viral pericarditis derives from the comprehensive workup of histological, cytological, immunobiological and molecular investigations in pericardial fluid and pericardial/epicardial biopsies; otherwise, the term presumed viral pericarditis should be used. […] For the diagnosis of purulent pericarditis, urgent pericardiocentesis is recommended and pericardial fluid should be sent for bacterial, fungal and tuberculous studies.

• #2 Pericarditis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericarditis-diagnosis/

  […] […] ECG […] There are four stages of ECG evolution in pericarditis, all of which are found in 60% of cases (figure 1). […] Stage 1 (hours to days): Diffuse ST elevation and PR depression, ST depression in aVR only […] Stage 2 (within first week): ST and PR segments normalize […] Stage 3: Diffuse T wave inversion and ECG otherwise normal […] Stage 4: T waves return to normal (May have indefinite persistence of T wave inversion) […] […] […] Imaging […] CXR typically normal […] Large pericardial effusion is uncommon – cardiomegaly. […] Transthoracic echocardiography […] Pericardial effusion in up to 60% of cases, often mild. […] Wall motion abnormalities suggest ACS rather than pericarditis.

• #2 Pericarditis ECG Changes • LITFL • ECG Library Diagnosis

  https://litfl.com/pericarditis-ecg-library/

  TTE is useful in the early assessment of patients with suspected pericarditis to look for complications such as large pericardial effusion and cardiac tamponade […] Pericarditis is classically associated with ECG changes that evolve through four stages. […] Less than 50% of patients progress through all four classical stages and evolution of changes may not follow this typical pattern. […] PR segment depression is only reliably seen in viral pericarditis, not by other causes. It is often only an early transient phenomenon (lasting only hours). […] Get serial ECGs on any patient with chest pain.

• #2 Diagnosing Pericarditis | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/1101/p1695.html

  Pericarditis, or inflammation of the pericardium, is most often caused by viral infection. […] Chest radiographs, Doppler studies, and laboratory tests confirm the diagnosis and provide information about the degree of effusion. […] The diagnosis of pericarditis and its complications requires a high index of suspicion. Clinical features and the probability of a cause of pericarditis may assist in recognition. Potential confirmatory studies include the electrocardiogram (ECG), the chest radiograph, Doppler studies, and selected laboratory tests. […] In acute pericarditis, the ECG typically shows ST-segment elevation in all leads, with an upward concavity of the elevation (so-called smiling face). […] If more than 250 mL of fluid has accumulated, the cardiac silhouette is usually enlarged on the chest radiograph. […] The diagnostic test of choice for large effusions, cardiac tamponade, and constrictive pericarditis is two-dimensional Doppler echocardiography. […] Laboratory studies are useful for excluding other possible causes of symptoms and clarifying the underlying cause of pericarditis.

• #2 Symptoms and Diagnosis of Pericarditis | American Stroke Association

  https://www.stroke.org/en/health-topics/pericarditis/symptoms-and-diagnosis-of-pericarditis

  The most common tests used to diagnose pericarditis and its severity are: […] Blood tests: May be recommended to find out if you’ve had a heart attack, the cause of your pericarditis and the amount of inflammation in your pericardium. […] EKG (electrocardiogram): Measures your heart’s electrical activity and certain results may suggest pericarditis. […] Chest X-ray: Takes pictures of the inside of the chest, including your heart, lungs and blood vessels. An X-ray can show whether your heart is enlarged due to excess fluid in your pericardium. It may also reveal signs of infection, sarcoidosis or malignancies that may cause pericarditis. […] Echocardiography (Echo): This test uses sound waves to create pictures of your heart, showing its size, shape and how well it’s working. It can show fluid build-up in the pericardium.

• #2 Acute Pericarditis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p553.html

  Acute pericarditis, inflammation of the pericardium, is found in approximately 5% of patients admitted to the emergency department for chest pain unrelated to acute myocardial infarction. […] Acute pericarditis is the most common affliction of the pericardium. It is diagnosed in approximately 0.1% of patients hospitalized for chest pain and in 5% of patients admitted to the emergency department for chest pain unrelated to acute myocardial infarction (MI). […] Evaluation of patients with acute pericarditis should include a history, physical examination, electrocardiography, chest radiography, and baseline laboratory studies (i.e., complete blood count, basic metabolic panel, troponin-I and creatine kinase levels, erythrocyte sedimentation rate, and serum C-reactive protein levels). […] Diagnosis requires at least two of the following criteria: characteristic sharp, pleuritic chest pain; pericardial friction rub; suggestive changes on electrocardiography; and a new or worsening pericardial effusion.

• #2 Symptoms and Diagnosis of Pericarditis | American Stroke Association

  https://www.stroke.org/en/health-topics/pericarditis/symptoms-and-diagnosis-of-pericarditis

  Cardiac CT (computed tomography): This type of X-ray takes a clear, detailed picture of your heart and pericardium. It helps rule out other causes of chest pain. […] Cardiac MRI (magnetic resonance imaging): Also called CMR, this test uses magnets and radio waves to form detailed pictures of your organs and tissues. It can show changes in the pericardium.

• #2 Acute pericarditis – EMCrit Project

  https://emcrit.org/ibcc/pericarditis/

  Troponin is frequently elevated (with sensitivity depending on the assay). […] Troponin elevation is disproportionately low, as compared to MI. […] Elevated troponin may imply a certain degree of myopericarditis (rather than purely pericarditis). […] CRP elevation has a sensitivity of ~80%, but such elevations are often minimal (often utilizing a cutoff value of 3 mg/L). […] Higher CRP levels may predict a greater risk of recurrence. […] Serial measurement of CRP may help monitor disease activity over time. […] Echocardiography is generally recommended. […] Ventricular dysfunction raises the possibility of perimyocarditis. […] Most patients will not require pericardiocentesis. […] Suspected bacterial, tuberculous, or neoplastic pericarditis (and effusion is large enough to access safely).

• #2 Pericarditis

  https://elsevier.health/en-US/preview/pericarditis

  For patients with suspected purulent pericarditis, send pericardial fluid for Gram stain, acid-fast stain, and WBC count, neutrophil count, and serum glucose ratio. […] Pericardial biopsy is indicated for patients with suspected tuberculous pericarditis and symptoms lasting longer than 3 weeks without identifiable cause.

• #2 Acute Pericarditis: A Diagnosis of Exclusion – ACEP Now

  https://www.acepnow.com/article/acute-pericarditis-a-diagnosis-of-exclusion/?singlepage=1

  While pericarditis is an unusual diagnosis, with an annual incidence of 27.7 per 100,000 persons, the recurrence rate of almost 30 percent is surprisingly high. […] The good news is that timely diagnosis and appropriate treatment options have been shown to decrease recurrence rates and help prevent chronic complications. […] However, considering that the clinical presentation, electrocardiogram (ECG), and laboratory findings may be confused with more deadly causes of chest pain such as myocardial infarction (MI), aortic dissection, and pulmonary embolism, pericarditis should be considered a diagnosis of exclusion in the ED. […] Despite these distinguishing features, however, there is no group of clinical features with sufficient specificity to rule in pericarditis with certainty, underlining the concept that it should be considered a diagnosis of exclusion.

• #2 Acute Pericarditis: A Diagnosis of Exclusion – ACEP Now

  https://www.acepnow.com/article/acute-pericarditis-a-diagnosis-of-exclusion/?singlepage=1

  The diagnosis of pericarditis requires two out of four of the following criteria: Pericarditis chest paintypically sharp, pleuritic, positional (greater than 8090 percent of cases), Pericardial rub on auscultation (less than one third of cases), New widespread ST elevation or PR depression on ECG (up to 60 percent of cases), New or worsening pericardial effusion (up to 60 percent of cases). […] The ECG findings of pericarditis, in particular, may be confused with early repolarization and acute MI. […] Nonetheless, all of these findings can be seen in patients with cardiac ischemia, underlining again the importance of approaching pericarditis as a diagnosis of exclusion. […] Troponin, in one study, was elevated in one third of cases of pericarditis, and is often associated with STE on ECG and pericardial effusion.

• #2 Pathophysiology and Diagnosis of Constrictive Pericarditis

  https://www.acc.org/latest-in-cardiology/articles/2017/03/13/15/10/pathophysiology-and-diagnosis-of-constrictive-pericarditis

  As an initial diagnostic test, echocardiography can confirm the diagnosis of CP in most cases if pre-test probability is sufficiently high. Echocardiography demonstrates features of both exaggerated ventricular interdependence and intrathoracic-intracardiac dissociation. […] Cardiac catheterization remains the gold standard diagnostic test, if non-invasive testing is inconclusive, to assess for presence of constriction and evaluate hemodynamic significance.

• #2 Purulent pericarditis: A rare diagnosis | Revista Portuguesa de Cardiologia (English edition)

  https://revportcardiol.org/en-purulent-pericarditis-a-rare-diagnosis-articulo-S2174204913001748

  The diagnosis can only be confirmed by pericardiocentesis (which in such cases in therapeutic) by means of macroscopic examination of the fluid, which has the biochemical characteristics of an exudate and should be subjected to microscopic study, direct and in culture, to screen for bacteria, fungi and AARB. […] Treatment must include drainage of the pericardial space, combined with systemic antibiotic therapy, initially empirical and then adjusted according to the results of microbiological study. […] Without drainage of the pericardial space, purulent pericarditis leads inexorably to death. […] Mortality in patients who are promptly diagnosed and appropriately treated is 40%, generally due to cardiac tamponade, septic shock or constriction. […] Prompt diagnosis of purulent pericarditis and initiation of appropriate treatment are the mainstays of successful management of this rare but potentially lethal entity.

• #2 Recurrent Pericarditis | American Heart Association

  https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis/recurrent-pericarditis

  Echocardiogram: Sound waves create pictures of your heart’s size, shape and how it’s working. This can reveal fluid buildup in the pericardium. […] Cardiac CT (computed tomography): A type of X-ray that takes a clear, detailed picture of your heart. […] Cardiac MRI (magnetic resonance imaging): Also called CMR, this test uses magnets and radio waves to create detailed images of your organs and tissues. This can reveal changes in the pericardium.

• #2 Acute Pericarditis: A Diagnosis of Exclusion – ACEP Now

  https://www.acepnow.com/article/acute-pericarditis-a-diagnosis-of-exclusion/?singlepage=1

  Prevention of recurrence is perhaps the most important aspect of ED treatment of acute uncomplicated pericarditis because recurrence leads to long-term morbidity. […] Next time you are faced with a patient with chest pain in the ED, first, rule out other more deadly causes of chest pain first (understanding that there are no clinical features specific to pericarditis), carefully scrutinize the ECG (realizing that no finding is 100 percent specific for pericarditis), and if you arrive at a diagnosis of uncomplicated viral or idiopathic acute pericarditis, be sure to start the patient on colchicine and NSAIDs and also ensure tight follow-up to monitor the clinical course and consideration of serial CRP measurements.

• #3 Pericarditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431080/

  Pericarditis, the most common pathological condition affecting the pericardium, involves the inflammation of the pericardial sac surrounding the heart. […] Diagnostic evaluation typically includes an electrocardiogram, echocardiogram, and chest x-ray, with additional laboratory tests to identify underlying causes. Understanding the nuances of pericarditis is crucial for effective diagnosis and management, especially given its potential for serious complications. […] Clinically, acute pericarditis is indicated by a characteristic description of chest pain and the presence of a pericardial friction rub upon auscultation. However, laboratory studies, ECG, and echocardiography are often necessary to confirm the diagnosis. According to the 2015 ESC guidelines, a diagnosis of acute pericarditis requires the presence of at least 2 out of 4 criteria, as mentioned below.

• #3 Acute pericarditis: Update on diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6964178/

  Diagnosis of acute pericarditis requires the presence of any two of: pericarditic chest pain; pericardial rub; saddle-shaped ST-elevation and/or PR-depression; non-trivial new or worsening pericardial effusion. […] Inpatient investigation and more intensive evaluation for a non-viral aetiology should be considered where there is any fever 38C; gradual onset; large effusion (20 mm) or tamponade; lack of response to 1 week of non-steroidal anti-inflammatory drugs or where there is any history of trauma, immunosuppression/deficiency or oral anticoagulant use. […] Diagnosis of pericarditis requires the presence of two of typical pericardial chest pain; pericardial friction rub; widespread ST-elevation and/or PR-depression; and a new or increasing non-trivial pericardial effusion. […] If diagnostic uncertainty remains, cardiovascular magnetic resonance with T2-weighted and late gadolinium enhancement imaging can be helpful for confirming the presence of any pericardial inflammation, and excluding concomitant myocarditis as well as other differentials.

• #3 Pericarditis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericarditis-diagnosis/

  Absence of reciprocal ST changes […] Absence of QRS widening and QT prolongation in leads with ST elevation […] […] […] Laboratory Findings […] WBC, CRP and ESR are likely to be elevated. […] Troponin may be elevated in 30% – concomitant myocarditis. […] […] […] Clinical Presentation […] History […] Quick onset, sharp chest pain: […] Pleuritic – worse on inspiration […] Improves with sitting and leaning forward […] May radiate to neck, back, shoulder and/or jaw […] May be preceded by a gastrointestinal or “flu-like” syndrome. […] Physical Examination […] Tachycardic, tachypneic, fever […] Friction rub highly specific but only present in 30% of cases […] Can fluctuate hourly. […] Heard best at end expiration, with the patient leaning forward.

• #3 Pericarditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431080/

  Supporting findings may include elevated inflammatory biomarkers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and leukocytosis) and evidence of pericardial inflammation on advanced imaging, such as cardiac computed tomography (CT) and cardiovascular magnetic resonance imaging (MRI). […] All patients with suspected acute pericarditis should undergo an ECG, echocardiogram, and chest x-ray. Myocardial inflammatory and injury markers, such as ESR, CRP, and troponins, should also be measured. […] Most patients will have idiopathic acute pericarditis, which can be safely managed on an outpatient basis with medical therapy alone. […] Patients exhibiting markers of poor prognosis or those who do not respond to therapy within 1 week should be admitted for further evaluation.

• #3 Acute Pericarditis: A Diagnosis of Exclusion – ACEP Now

  https://www.acepnow.com/article/acute-pericarditis-a-diagnosis-of-exclusion/?singlepage=1

  The diagnosis of pericarditis requires two out of four of the following criteria: Pericarditis chest paintypically sharp, pleuritic, positional (greater than 8090 percent of cases), Pericardial rub on auscultation (less than one third of cases), New widespread ST elevation or PR depression on ECG (up to 60 percent of cases), New or worsening pericardial effusion (up to 60 percent of cases). […] The ECG findings of pericarditis, in particular, may be confused with early repolarization and acute MI. […] Nonetheless, all of these findings can be seen in patients with cardiac ischemia, underlining again the importance of approaching pericarditis as a diagnosis of exclusion. […] Troponin, in one study, was elevated in one third of cases of pericarditis, and is often associated with STE on ECG and pericardial effusion.

• #3 Pericarditis ECG Changes • LITFL • ECG Library Diagnosis

  https://litfl.com/pericarditis-ecg-library/

  TTE is useful in the early assessment of patients with suspected pericarditis to look for complications such as large pericardial effusion and cardiac tamponade […] Pericarditis is classically associated with ECG changes that evolve through four stages. […] Less than 50% of patients progress through all four classical stages and evolution of changes may not follow this typical pattern. […] PR segment depression is only reliably seen in viral pericarditis, not by other causes. It is often only an early transient phenomenon (lasting only hours). […] Get serial ECGs on any patient with chest pain.

• #3 Pericarditis – Core EM

  https://coreem.net/core/pericarditis/

  Definition: Inflammation of the partial and/or visceral layers of the pericardium surrounding the heart. The inflammation is characterized by lymphocytes and granulocytes infiltrating the pericardium. […] Diagnosis […] Diagnostic Criteria (2 out of 4 required) […] Classic chest pain history: sharp, pleuritic and positional with radiation to the trapezius ridge […] Pericardial friction rub […] Pericardial effusion on echocardiogram […] Characteristic EKG findings […] EKG is a reliable diagnostic tool. However, EKG changes occur in stages over time and classic findings may not be present depending on the duration of symptoms […] The first step in diagnosis of pericarditis should be to think about and eliminate STEMI as the diagnosis […] No lab test has a high enough sensitivity or specificity to either rule-in or rule-out pericarditis or differentiate it from MI

• #3 Acute Pericarditis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p553.html

  Transthoracic echocardiography should be performed to exclude a pericardial effusion and cardiac tamponade. […] The absence of a pericardial effusion does not exclude acute pericarditis. […] Clinical presentation should dictate other testing and imaging to determine the etiology of the pericarditis.

• #3 Chronic Pericarditis – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/pericardial-disease-and-myocarditis/chronic-pericarditis

  Magnetic resonance imaging (MRI) or computed tomography (CT) can be used to determine the thickness of the pericardium. Normally, the pericardium is less than 1/8 inch (3 millimeters) thick, but in chronic constrictive pericarditis, it is usually about one fifth of an inch (5 millimeters) thick or more. […] A biopsy may be done to help determine the cause of chronic pericarditis for example, tuberculosis. A small sample of the pericardium is removed during exploratory surgery and examined under a microscope. Alternatively, a sample can be removed using a pericardioscope (a fiberoptic tube used to view the pericardium and to obtain tissue samples) inserted through an incision in the chest. […] Laboratory tests on samples of blood and fluid from the pericardium may also be needed to help determine the cause of pericarditis.

• #3 New Diagnostic Criteria for Acute Pericarditis: A Cardiac MRI Perspective

  https://www.acc.org/Latest-in-Cardiology/Articles/2015/11/05/11/08/New-Diagnostic-Criteria-for-Acute-Pericarditis

  Currently, the diagnosis of acute pericarditis is based on demonstrating at least two of the following four criteria: 1. Non-ischemic chest pain, 2. ECG evidence of PR depression or ST segment deviation, 3. Detection of a pericardial rub on auscultation and 4. Pericardial effusion on 2-D echocardiography. […] It is well known that ECG evidence is often lacking and that a pericardial rub is often fleeting and not easily detected. […] From a practical standpoint, the only reliable criterion is symptomatic chest pain, often making the diagnosis difficult to definitively establish. […] As an ancillary diagnostic tool, laboratory confirmation of an inflammatory process, such as an elevated sed rate, is sometimes used to support the diagnosis of acute pericarditis, but is non-specific. […] Data presented at the 2014 American College of Cardiology Annual Scientific Session attempted to systematically study a series of chest pain patients for evaluation of pericarditis by cardiac MRI using T2 weighted and late gadolinium imaging sequences.

• #3 Pericarditis: symptoms, diagnosis, treatment | ClinCaseQuest

  https://clincasequest.hospital/pericarditis/

  The diagnosis is clinical and can be made based on two of the following criteria: […] Pericarditis, acute pericarditis, pericardial disease, pericarditis diagnostics, Pericarditis diagnostic criteria, pericarditis treatment […] In the management of pericardial syndromes, a major controversy is the role of an extensive aetiological search and admission for all patients with pericarditis or pericardial effusion. […] According to the 2015 ESC guidelines on pericardial disease, the definite diagnosis of viral pericarditis derives from the comprehensive workup of histological, cytological, immunobiological and molecular investigations in pericardial fluid and pericardial/epicardial biopsies; otherwise, the term presumed viral pericarditis should be used. […] For the diagnosis of purulent pericarditis, urgent pericardiocentesis is recommended and pericardial fluid should be sent for bacterial, fungal and tuberculous studies.

• #3 Acute Pericarditis: A Diagnosis of Exclusion – ACEP Now

  https://www.acepnow.com/article/acute-pericarditis-a-diagnosis-of-exclusion/?singlepage=1

  Prevention of recurrence is perhaps the most important aspect of ED treatment of acute uncomplicated pericarditis because recurrence leads to long-term morbidity. […] Next time you are faced with a patient with chest pain in the ED, first, rule out other more deadly causes of chest pain first (understanding that there are no clinical features specific to pericarditis), carefully scrutinize the ECG (realizing that no finding is 100 percent specific for pericarditis), and if you arrive at a diagnosis of uncomplicated viral or idiopathic acute pericarditis, be sure to start the patient on colchicine and NSAIDs and also ensure tight follow-up to monitor the clinical course and consideration of serial CRP measurements.

• #3 Pericarditis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pericarditis/

  The diagnostic approach and findings for chronic pericarditis are similar to acute pericarditis but ECG, echocardiography, and imaging findings may vary. […] The diagnosis of constrictive pericarditis is based on characteristic imaging findings (most commonly echocardiography but MRI and CT may be used). […] The diagnostic findings of effusive-constrictive pericarditis are similar to those of pericardial effusion, with the exception that in addition to pericardial effusion, pericardial thickening may also be seen.

• #3 Acute Pericarditis Differential Diagnoses

  https://emedicine.medscape.com/article/156951-differential

  The classic feature of chest pain and dyspnea with pericarditis may be subtle and can be confused with other diagnoses, particularly in elderly individuals. […] Given an overall lack of specificity of clinical features, diagnostic protocols to determine the etiology for pericarditis have been described. Following specific protocols, several investigators determined a specific etiology in 14-22% of patients. […] The diagnosis of chylopericardium is made with the following criteria (class I, level C evidence): Presence of a milky opalescent pericardial effusion, Triglyceride level over 500 mg/dL, Cholesterol-to-triglyceride ratio below 1, Negative cultures, Lymphocytic predominance (lymphocyte count between a few hundred to several thousand per mL). […] Aside from clues elicited from the history and physical examination, pericarditis can be difficult to distinguish from myocardial infarction (MI) and repolarization in patients who present with chest pain and ST-segment elevation on electrocardiograms (ECGs). […] Some ECG findings that may be helpful include the following: Repolarization does not progress through stages and is uncommonly associated with PR depression; serial monitoring of ECGs in young patients with chest pain helps differentiate early repolarization from acute pericarditis.

• #3 Pericarditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431080/

  In most patients, empiric treatment with high-dose anti-inflammatory agents, in addition to colchicine, is recommended. Nonsteroidal anti-inflammatory drug (NSAID) therapy should continue until symptom relief is achieved, which typically occurs within 3 days to 2 weeks. […] The COPE trial randomized 120 patients to receive either conventional therapy with acetylsalicylic acid (ASA, also known as aspirin) or conventional therapy with adjunctive colchicine, following them for 18 months. […] For corticosteroid-dependent recurrent pericarditis, steroid-sparing immunosuppressive agents such as azathioprine, intravenous immunoglobulin (IVIG), or anakinra (an interleukin-1 receptor antagonist) may be considered as third-line therapy.

• #3 Pericardial Disease

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/pericardial-disease/

  Acute pericarditis is an inflammatory process involving the pericardium that results in a clinical syndrome characterized by chest pain, pericardial friction rub, changes in the electrocardiogram (ECG) and occasionally, a pericardial effusion. Generally, the diagnosis requires 2 of these 3 features. […] The diagnosis of acute pericarditis remains a clinical one based on history, physical examination, ECG and the echocardiogram. Other imaging studies, including computed tomography (CT) and magnetic resonance imaging (MRI) may be used in selected cases to investigate the pericardium. […] The ECG in acute pericarditis has four consecutive stages. Stage 1, characterized by diffuse concave-upwards ST elevation and PR segment deviation in the direction opposite from the P polarity, is the most useful stage for the diagnosis of acute pericarditis. […] The diagnosis of post-MI pericarditis requires symptoms or a new pericardial friction rub; a pericardial effusion alone is nonspecific. […] The diagnosis of cardiac tamponade is a clinical diagnosis with echocardiographic confirmation.

• #4 Pericarditis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pericarditis/

  Check ECG, TTE to determine if diagnostic criteria are met. […] If TTE is inconclusive, consider CT or cardiac MRI to confirm pericardial inflammation/effusion. […] Rule out other causes of acute chest pain (e.g., myocardial infarction, myocarditis) before making a diagnosis of acute pericarditis. […] At least two of the following four criteria must be present for a diagnosis of acute pericarditis: Characteristic chest pain, Pericardial friction rub, Typical ECG features of pericarditis, New or worsening pericardial effusion. […] The goal of imaging is to identify any new pericardial effusion and rule out alternative etiologies. […] Echocardiography is often normal in patients with pericarditis but is needed to rule out pericardial tamponade and pericardial constriction. […] Elevation of inflammatory markers may support the diagnosis of pericarditis but are not considered to be a part of the diagnostic criteria.

• #4 Acute Pericarditis Workup: Approach Considerations, Routine Laboratory Studies, Chest Radiography

  https://emedicine.medscape.com/article/156951-workup

  Obtain electrocardiography (ECG), transthoracic echocardiography (TTE), and/or chest radiography in all individuals with suspected acute pericarditis. […] Evaluate markers of inflammation (ie, C-reactive protein [CRP]) and myocardial injury (ie, creatine kinase [CK], troponin) when acute pericarditis is suspected. […] Obtain TTE in all patients with suspected pericardial effusion (class I). […] Obtain chest radiography in patients with suspected pericardial effusion or pleuropulmonary involvement (class I). […] Evaluate markers of inflammation (ie, CRP) in patients with suspected pericardial effusion (class I). […] Obtain echocardiography as the first imaging modality for suspected cardiac tamponade to evaluate the size, location, and degree of hemodynamic impact of the pericardial effusion.

• #4 Acute Pericarditis Workup: Approach Considerations, Routine Laboratory Studies, Chest Radiography

  https://emedicine.medscape.com/article/156951-workup

  Perform urgent pericardiocentesis (or cardiac surgery) for cardiac tamponade. […] For a definitive diagnosis of viral pericarditis, perform a comprehensive workup comprising histologic, cytologic, immunohistologic, and molecular studies in pericardial fluid; consider peri-/epicardial biopsies (class IIa). […] Perform urgent pericardiocentesis for the diagnosis of purulent pericarditis Send pericardial fluid for bacterial, fungal, and tuberculous studies, and draw blood for cultures. […] The initial evaluation includes a clinical history and physical examination; ECG; chest radiography, echocardiography, CT scanning, CMRI, positron-emission tomography (PET) scanning, or PET/CT scanning, as indicated; and initial laboratory work. […] Pericardiocentesis should be performed on all patients with cardiac tamponade or suspected purulent pericarditis. […] The pericardial fluid should be analyzed for red blood cells (RBCs), total protein level, LDH level, adenosine deaminase activity, and culture (ordinary and Loewenstein media).

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