From the Guidelines
Pericarditis is characterized by sharp, stabbing chest pain, a pericardial friction rub, and ECG findings of widespread ST-segment elevation and PR-segment depression, as outlined in the European Heart Journal guidelines 1. The clinical presentation of pericarditis typically includes:
- Sharp, stabbing chest pain that worsens when lying down, breathing deeply, or coughing, and improves when sitting up and leaning forward
- Pericardial friction rub, a scratching or grating sound heard with a stethoscope over the heart
- Fever, weakness, fatigue, cough, and difficulty breathing
- Referred pain to the neck, shoulder, back, or abdomen
- In severe cases, symptoms of cardiac tamponade such as hypotension, distant heart sounds, and paradoxical pulse may occur ECG findings often show:
- Widespread ST-segment elevation, particularly in leads I, II, aVL, aVF, and V3-V6, with ST segment depression in aVR, V1, and occasionally V2 1
- PR-segment deviations opposite to P polarity, with early stage II showing ST junctions returning to baseline and PR deviation, and late stage II showing T waves progressively flattening and inverting 1 Diagnosis is typically made using a combination of:
- Auscultation for pericardial rub
- ECG to evaluate for ST-segment elevation and PR-segment depression
- Echocardiography to assess for pericardial effusion and signs of tamponade
- Blood analyses for inflammation markers, such as ESR, CRP, LDH, and leukocytes, as well as troponin I and CK-MB to evaluate for myocardial lesion 1 The diagnosis and management of pericarditis should be guided by the most recent and highest quality evidence, with a focus on reducing morbidity, mortality, and improving quality of life 1.
From the Research
Signs and Symptoms of Pericarditis
The provided studies do not directly discuss the signs and symptoms of pericarditis. However, they do mention the treatment and management of the condition, which can be related to its symptoms.
Treatment and Management
- The treatment of pericarditis typically involves anti-inflammatory therapy, with aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) being the mainstay of therapy 2.
- Colchicine is often used as an adjunct to NSAIDs, especially for recurrences 2, 3.
- Corticosteroids are used as a second choice for difficult cases, such as those with systemic autoimmune diseases or postpericardiotomy syndrome 2, 4.
- The use of colchicine monotherapy has been compared to NSAID monotherapy or combination therapy for the prevention of recurrent pericarditis in patients with heart failure with reduced ejection fraction and/or coronary artery disease 5.
Recurrence and Treatment Outcomes
- Recurrence is a common complication of pericarditis, occurring in up to 30% of patients 3.
- The use of colchicine has been shown to reduce the risk of recurrent pericarditis 3.
- Steroids, especially at low doses, may be considered a successful and safe treatment for acute and recurrent idiopathic pericarditis 4.
- A study comparing colchicine monotherapy to NSAID monotherapy or combination therapy found no difference in the incidence of pericarditis recurrence or documentation of incessant symptoms within 12 months of the index hospitalization 5.