From the Guidelines
Pericarditis diagnosis requires a comprehensive approach combining clinical evaluation, laboratory tests, and imaging studies, with initial workup including auscultation, ECG, transthoracic echocardiography, chest X-ray, and routine blood tests, as recommended by the 2015 ESC guidelines 1, 2. The diagnosis is established when at least two of the following criteria are present: typical chest pain (sharp, pleuritic, improving with sitting forward), pericardial friction rub on auscultation, characteristic ECG changes (widespread ST elevation or PR depression), or pericardial effusion on imaging. Some key points to consider in the diagnosis and workup of pericarditis include:
- Initial evaluation should include a complete blood count, comprehensive metabolic panel, cardiac biomarkers (troponin, CK-MB), inflammatory markers (ESR, CRP), and a 12-lead ECG.
- Echocardiography is the primary imaging modality to assess for effusion and cardiac function.
- Additional tests may include chest X-ray to evaluate heart size and lung fields, and in selected cases, cardiac MRI which can detect pericardial inflammation with high sensitivity.
- For cases with unclear etiology, further testing for infectious causes (blood cultures, viral serologies), autoimmune conditions (ANA, RF), or tuberculosis may be warranted.
- In patients with large effusions or hemodynamic compromise, pericardiocentesis may be both diagnostic and therapeutic.
- The workup should be tailored to the clinical presentation, with more extensive testing reserved for cases with atypical features, recurrent episodes, or poor response to initial therapy.
- Early diagnosis is crucial as it guides appropriate treatment and helps prevent complications like cardiac tamponade or constrictive pericarditis, as noted in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline 3. It's also important to consider the role of other imaging modalities, such as CT and CMR, in the diagnosis and management of pericarditis, as well as the potential for pericardial involvement in neoplastic disease, as discussed in the 2015 ESC guidelines 4.