From the Guidelines
The diagnostic workup for pericarditis in pregnancy should begin with a thorough history and physical examination, focusing on chest pain characteristics, fever, and recent illnesses, followed by initial diagnostic testing including an electrocardiogram (ECG), chest X-ray with appropriate shielding, and echocardiography, as recommended by the 2015 ESC guidelines 1. The workup should prioritize non-invasive tests to minimize risks to the fetus.
- Initial diagnostic testing should include:
- Electrocardiogram (ECG) to look for diffuse ST-segment elevation, PR depression, and electrical alternans
- Chest X-ray with appropriate shielding to evaluate for cardiomegaly
- Echocardiography to assess for pericardial effusion and cardiac function
- Laboratory tests should include:
- Complete blood count
- Comprehensive metabolic panel
- Cardiac biomarkers (troponin, CK-MB)
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Thyroid function tests Additional testing may be considered based on clinical suspicion, such as viral serologies or autoimmune markers like ANA and rheumatoid factor, as per the guidelines 1. It is essential to note that the management of pericarditis in pregnancy requires a multidisciplinary approach, involving cardiology, maternal-fetal medicine, and sometimes rheumatology, to balance maternal treatment needs with fetal safety considerations, as outlined in the 2015 ESC guidelines 1.
From the Research
Diagnostic Workup for Pericarditis in Pregnancy
- The diagnostic workup for pericarditis in pregnancy typically involves an electrocardiogram (ECG) and transthoracic echocardiogram (TTE) in the appropriate clinical context 2, 3, 4.
- Physiologic cardiovascular adaptations during pregnancy can complicate diagnosis, but these tests are usually sufficient for most patients 2.
- The clinical presentation, including symptoms and physical examination findings, is also critical in diagnosing pericarditis in pregnancy 5.
Diagnostic Considerations
- Pericardial effusion is the most common manifestation of pericardial diseases during pregnancy, and it is usually benign and well-tolerated 3.
- Acute pericarditis is the second most common condition, usually requiring medical therapy during pregnancy 3.
- Cardiac tamponade and constrictive pericarditis are rare in pregnancy, but prompt diagnosis and management are critical 5.