From the Guidelines
Pericarditis can be diagnosed by a combination of clinical evaluation, laboratory tests, and imaging studies, with a first diagnostic evaluation recommended to include auscultation, ECG, transthoracic echocardiography, chest X-ray, and routine blood tests, including markers of inflammation, as stated in the 2015 ESC guidelines 1. The diagnosis of pericarditis typically begins with a thorough history and physical examination, focusing on characteristic symptoms like sharp chest pain that worsens with lying down and improves with sitting forward, along with a pericardial friction rub on auscultation.
- Key diagnostic tools include:
- Electrocardiogram (ECG) to show widespread ST-segment elevation, PR-segment depression, and eventual T-wave inversions
- Echocardiography to detect pericardial effusion or thickening
- Chest X-ray to evaluate for an enlarged cardiac silhouette
- Laboratory tests for elevated inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
- Assessment of markers of myocardial injury (i.e. CK, troponin) as recommended in the guidelines 1 The initial diagnostic workup should also include CT and/or CMR as second-level testing for diagnostic workup in pericarditis, as recommended by the guidelines 1. In certain situations, pericardiocentesis might be performed for diagnostic purposes, especially when there's significant effusion or suspicion of infectious or malignant causes, as indicated in the guidelines 1. The diagnosis is confirmed when a patient presents with at least two of the following: typical chest pain, pericardial friction rub, characteristic ECG changes, or pericardial effusion on imaging, with the guidelines providing a comprehensive approach to diagnosis and management 1.
From the Research
Diagnosis of Pericarditis
Pericarditis can be diagnosed by the presence of 2 or more of the following symptoms:
- Sharp, pleuritic chest pain that worsens when supine (≈90%) 2
- New widespread electrocardiographic ST-segment elevation and PR depression (≈25%-50%) 2, 3
- A new or increased pericardial effusion that is most often small (≈60%) 2
- A pericardial friction rub (<30%) 2
Diagnostic Tools
The following diagnostic tools can be used to support the diagnosis of pericarditis:
- Electrocardiogram (ECG) to detect ST-segment elevation and PR depression 3, 4
- Echocardiography to detect pericardial effusion 2, 4
- Cardiac magnetic resonance to diagnose concurrent myocarditis 3
Clinical Features
The clinical features of pericarditis may vary depending on the patient's age and the presence of myocardial involvement: