SHM's Clinical Quick Talks-Acute Pericarditis

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Acute pericarditis is the inflammation of the pericardial sac, which normally contains 15-50 mL of fluid. It is typically idiopathic but can be caused by viral or bacterial infections, malignancy, autoimmune conditions, or kidney disease. Differential diagnoses include myocardial infarction, pulmonary embolism, and others.<br /><br />Diagnosis requires at least two of the following: chest pain, EKG changes, pericardial effusion, or friction rub. Chest pain is sudden, sharp, and may improve when sitting up. A pericardial friction rub sounds scratchy and can be detected via stethoscope. EKG changes may include diffuse ST elevations and reciprocal depressions, although these aren't always present. <br /><br />The diagnostic evaluation involves history-taking, physical exams, lab tests, and imaging studies like EKGs, chest X-rays, and echocardiograms to check for effusion. Blood tests might be conducted to identify infections or autoimmune conditions.<br /><br />Treatment aims to alleviate pain, reduce inflammation, and prevent recurrence, and it traditionally uses NSAIDs and colchicine. High-risk patients might require hospital admission. NSAIDs should be tapered once symptoms resolve, and physical activity restricted during recovery. Steroids can be used if NSAIDs and colchicine are ineffective or contraindicated. GI prophylaxis with PPIs may be necessary for specific patients. <br /><br />Key points: Two diagnostic criteria are needed for confirmation, and treatment generally involves colchicine and NSAIDs while avoiding strenuous activity. The condition is mostly idiopathic but can also be due to various other health issues. The information was last updated in October 2024. <br /><br />Sources include UpToDate references and clinical guidelines for the condition.

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Sadia Nawshin, Nicole Terrigno

Keywords

acute pericarditis

pericardial inflammation

idiopathic

diagnostic criteria

NSAIDs

colchicine

EKG changes

chest pain

pericardial effusion

treatment