From the Guidelines
Pericarditis is diagnosed through a combination of clinical findings, laboratory tests, and imaging studies, requiring at least two of the following criteria: typical chest pain, pericardial friction rub, characteristic ECG changes, and pericardial effusion on imaging, as recommended by the 2015 ESC guidelines 1. The diagnosis of pericarditis involves a comprehensive approach, including:
- Clinical findings: typical chest pain (sharp, pleuritic, improved by sitting forward) and pericardial friction rub on auscultation
- Laboratory tests: inflammatory markers (ESR, CRP) and cardiac biomarkers to rule out myocardial injury
- Imaging studies: echocardiography to detect pericardial effusion and assess for signs of cardiac tamponade, with additional imaging using chest X-ray, CT, or cardiac MRI as needed The 2015 ESC guidelines recommend a first diagnostic evaluation with auscultation, ECG, transthoracic echocardiography, chest X-ray, and routine blood tests, including markers of inflammation and myocardial lesion tests 1. The diagnosis requires a thorough assessment of the patient's clinical presentation, laboratory results, and imaging findings to establish the diagnosis and guide treatment, with a focus on identifying high-risk features and specific causes of pericarditis, such as bacterial or neoplastic pericarditis, as outlined in the 2015 ESC guidelines 1. Key considerations in the diagnosis of pericarditis include:
- Identifying high-risk features, such as fever, subacute course, large pericardial effusion, cardiac tamponade, and failure of aspirin or NSAIDs
- Ruling out specific causes of pericarditis, such as bacterial or neoplastic pericarditis
- Assessing the need for hospitalization and a full aetiological search based on the presence of high-risk features The 2015 ESC guidelines provide a comprehensive framework for the diagnosis and management of pericardial diseases, emphasizing the importance of a thorough diagnostic evaluation and individualized treatment approach 1.
From the Research
Clinical Criteria for Diagnosing Pericarditis
The clinical criteria for diagnosing pericarditis include:
- New or worsening pericardial effusion
- Characteristic pleuritic chest pain
- Pericardial friction rub
- Electrocardiographic changes, including new, widespread ST elevations or PR depressions 2, 3
Electrocardiographic Findings
Classic electrocardiographic findings in pericarditis include:
- PR-segment depressions
- Diffuse, concave, upward ST-segment elevations without reciprocal changes
- T-wave inversions 2, 4
Diagnostic Evaluation
Diagnostic evaluation of pericarditis should include:
- Transthoracic echocardiography to characterize the size of effusions and evaluate for complications 2
- Electrocardiogram to assess for electrocardiographic changes 2, 3, 4
- Clinical evaluation, including history and physical examination, to assess for characteristic clinical findings such as pleuritic chest pain and pericardial friction rub 3, 5, 4
Common Causes and Treatment
The most common causes of acute pericarditis are idiopathic or viral, and the most common treatment for these are nonsteroidal anti-inflammatory drugs and colchicine 2, 3, 6, 4