From the Guidelines
Pericarditis typically presents with sharp, pleuritic chest pain that worsens when lying flat and improves when sitting forward or leaning forward, as noted in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1. The pain may radiate to the neck, shoulders, or back and is often preceded by a viral prodrome with fever, myalgia, and malaise.
- On physical examination, a pericardial friction rub may be heard, which is a scratchy, high-pitched sound best appreciated during systole when the patient leans forward and holds their breath.
- ECG findings include widespread ST-segment elevation in most leads except aVR and V1, PR-segment depression, and absence of reciprocal ST-segment depression, as described in the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1.
- Laboratory tests often show elevated inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate.
- Echocardiography may reveal a pericardial effusion, though its absence doesn't exclude the diagnosis. Patients may also experience dyspnea, especially if there is a significant effusion causing cardiac tamponade, which would present with Beck's triad (hypotension, jugular venous distention, and muffled heart sounds) and pulsus paradoxus. The clinical presentation varies based on the underlying cause, with viral and idiopathic being most common, followed by post-myocardial infarction, autoimmune disorders, uremia, and tuberculosis in endemic areas, as noted in the 2004 guidelines on the diagnosis and management of pericardial diseases executive summary 1.
From the Research
Clinical Presentation of Pericarditis
- Acute pericarditis is characterized by inflammation of the pericardium, presenting with acute, sharp, retrosternal chest pain that is relieved by sitting or leaning forward 2
- A pericardial friction rub is found in up to 85% of patients with acute pericarditis 2
- Classic electrocardiographic changes include widespread concave upward ST-segment elevation without reciprocal T-wave inversions or Q waves 2
- The condition can be caused by various factors, including infection, acute myocardial infarction, medication use, trauma to the thoracic cavity, and systemic diseases such as rheumatoid arthritis 2
Symptoms and Diagnosis
- Patients with pericarditis commonly present with chest pain, which can be severe and debilitating 3, 2
- The diagnosis of pericarditis is based on clinical presentation, electrocardiographic changes, and imaging studies such as echocardiography 2
- Laboratory tests, including C-reactive protein and troponin levels, can also be used to support the diagnosis 4, 5
Treatment and Management
- First-line treatment for pericarditis includes nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine 4, 3, 2
- Glucocorticoids are reserved for severe or refractory cases, or in cases where the cause of pericarditis is likely connective tissue disease, autoreactivity, or uremia 4, 2
- Colchicine has been shown to be effective in reducing the number of pericarditis recurrences in patients with recurrent pericarditis or acute pericarditis 6