From the Guidelines
A pericarditis screen should include a comprehensive evaluation with auscultation, ECG, transthoracic echocardiography, chest X-ray, and routine blood tests, including markers of inflammation (i.e., CRP and/or ESR) and myocardial lesions (CK, troponins) as recommended by the European Society of Cardiology (ESC) guidelines 1. This approach is necessary because pericarditis has multiple potential causes, including viral infections, autoimmune disorders, post-cardiac injury, medications, and systemic diseases, and identifying the underlying cause guides appropriate treatment.
Key Components of the Pericarditis Screen
- Auscultation to assess for pericardial friction rub
- ECG to look for diffuse ST-segment elevation, PR depression, and electrical alternans
- Transthoracic echocardiography to assess for pericardial effusion and cardiac tamponade
- Chest X-ray to evaluate for an enlarged cardiac silhouette
- Routine blood tests, including: + Markers of inflammation (CRP and/or ESR) + Myocardial lesions (CK, troponins) + Complete blood count + Renal function tests + Liver tests ### Additional Testing CT and/or CMR are recommended as second-level testing for diagnostic workup in pericarditis 2. Further testing, such as viral studies and autoimmune markers, may be considered in cases without clear etiology or with high-risk features, such as fever, subacute course, large pericardial effusion, or cardiac tamponade 3. Pericardiocentesis or surgical drainage may be indicated in cases of cardiac tamponade or suspected bacterial and neoplastic pericarditis. Percutaneous or surgical pericardial biopsy may be considered in selected cases of suspected neoplastic or tuberculous pericarditis. This comprehensive approach is supported by the ESC guidelines and is essential for guiding appropriate treatment and improving patient outcomes.
From the Research
Pericarditis Screen
- Pericarditis is the most common form of pericardial disease and a relatively common cause of chest pain 4
- The diagnosis of pericarditis is based on clinical criteria including chest pain, a pericardial rub, electrocardiographic changes, and pericardial effusion 4, 5, 6
- Certain features at presentation (temperature >38°C, subacute course, large effusion or tamponade, and failure of nonsteroidal anti-inflammatory drug treatment) indicate a poorer prognosis and identify patients requiring hospital admission 4
Diagnosis Criteria
- Diagnosis of pericarditis requires at least two of the following criteria: new or worsening pericardial effusion, characteristic pleuritic chest pain, pericardial friction rub, or electrocardiographic changes, including new, widespread ST elevations or PR depressions 5, 6
- Electrocardiographic changes include PR-segment depressions, diffuse, concave, upward ST-segment elevations without reciprocal changes, and T-wave inversions 6
- Transthoracic echocardiography should be performed in all patients with acute pericarditis to characterize the size of effusions and evaluate for complications 6
Treatment Options
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment option for pericarditis 4, 5, 6, 7, 8
- Colchicine should be used in combination with first- or second-line treatments to reduce the risk of recurrence 4, 5, 6, 7
- Corticosteroids are often used if pericarditis does not improve with NSAIDs and colchicine, or for specific indications such as systemic inflammatory disease, pregnancy, or renal failure 5, 6, 7