From the Guidelines
To rule out pericarditis, you should order an electrocardiogram (ECG), transthoracic echocardiography, chest X-ray, routine blood tests, including markers of inflammation (i.e., CRP and/or ESR), and myocardial lesion tests (CK, troponins) as recommended by the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1. The ECG may show diffuse ST-segment elevation and PR-segment depression, which are classic findings in pericarditis. The initial diagnostic evaluation should include:
- Auscultation to detect a pericardial friction rub
- ECG to show diffuse ST-segment elevation and PR-segment depression
- Transthoracic echocardiography to assess for pericardial effusion and cardiac tamponade
- Chest X-ray to evaluate for cardiomegaly or pulmonary congestion
- Routine blood tests, including:
- Markers of inflammation (i.e., CRP and/or ESR)
- White blood cell count with differential count
- Renal function and liver tests
- Myocardial lesion tests (CK, troponins) In some cases, additional imaging such as cardiac MRI or CT scan may be necessary if the diagnosis remains uncertain after initial testing, as recommended by the 2015 ESC guidelines 1. A thorough history and physical examination are also essential, focusing on chest pain characteristics (typically sharp, pleuritic, and relieved by sitting forward) and the presence of a pericardial friction rub on auscultation, as described in the European Heart Journal 1.
From the Research
Diagnostic Tests for Pericarditis
To rule out pericarditis, the following tests can be ordered:
- Electrocardiogram (ECG) to check for widespread ST-segment elevation, which can be recorded in about one-quarter of patients with pericarditis 2
- Complete blood count, erythrocyte sedimentation rate and/or C-reactive protein to assess inflammation 3
- Cardiac enzymes to evaluate for myocardial involvement 3
- Chest radiographs to check for any cardiac abnormalities 3
- Echocardiogram with Doppler to assess for effusion and cardiac function 3
- Cardiac magnetic resonance to diagnose concurrent myocarditis 2
Importance of ECG in Diagnosing Pericarditis
ECG is a crucial tool in diagnosing pericarditis, as it can show characteristic changes such as widespread ST-segment elevation 2, 4 However, ECG changes may also imply concurrent myocardial involvement rather than simple pericarditis 2 Therefore, it is essential to interpret ECG results in conjunction with other diagnostic tests and clinical findings 2, 3, 4