From the Guidelines
The main manifestations of pericarditis include chest pain, fever, and a characteristic friction rub heard on auscultation, as described in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1. Chest pain is typically sharp, located in the center or left side of the chest, and often worsens when lying down or taking deep breaths. It may improve when sitting up and leaning forward. Fever is usually low-grade but can be more severe in some cases. The pericardial friction rub is a scratchy or grating sound heard with a stethoscope, caused by the inflamed layers of the pericardium rubbing against each other. It's best heard at the left lower sternal border. Other possible manifestations include:
- Fatigue and weakness
- Cough
- Shortness of breath
- Palpitations
- Swelling in the legs or abdomen (if pericardial effusion develops) In some cases, ECG changes may be present, typically showing widespread ST-segment elevation and PR-segment depression, as noted in the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1. These symptoms occur due to inflammation of the pericardium, the protective sac surrounding the heart. The inflammation causes the normally smooth pericardial surfaces to become rough and irritated, leading to pain and the characteristic friction rub. Understanding these manifestations is crucial for prompt diagnosis and appropriate management of pericarditis, as emphasized in the guidelines 1.
From the Research
Clinical Manifestations of Pericarditis
The clinical manifestations of pericarditis include:
- Sharp, pleuritic chest pain that worsens when supine [@\1@, @\2@, @\3@, @\4@]
- Pericardial friction rub [@\1@, @\2@, @\4@]
- Electrocardiographic changes such as diffuse concave-upward ST-segment elevation and PR-segment depression [@\2@, @\4@]
- Pericardial effusion [@\1@, @\2@]
- Elevation of markers of inflammation [@\1@]
- Imaging evidence of pericardial inflammation by CT or cardiac MR [@\1@]
Diagnosis and Treatment
The diagnosis of pericarditis is based on the presence of two or more of the following: sharp, pleuritic chest pain, new widespread electrocardiographic ST-segment elevation and PR depression, a new or increased pericardial effusion, or a pericardial friction rub [@\2@]. The treatment of pericarditis typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine [@\1@, @\2@, @\3@]. Corticosteroids may be used in refractory cases or for relapse [@\1@, @\2@, @\3@].
Complicated Pericarditis
Complicated pericarditis can develop in a minority of patients, and is associated with risk factors such as early high-dose corticosteroids, a lack of colchicine, and an elevated high-sensitivity C-reactive protein [@\5@]. The care of these patients requires multimodality imaging, and novel treatments such as therapies that target the inflammasome may lead to more durable remission and resolution [@\5@].