UMEM Educational Pearls

Acute Pericarditis

- Pericarditis has numerous etiologies; in developed countries 80-90% of cases are idiopathic/viral & 10-20% of cases are most commonly post-cardiac injury syndromes, connective-tissue diseases, or cancer.

- Diagnosis requires at least two of the following symptoms or signs: chest pain, pericardial friction rub, typical electrocardiographic changes, and pericardial effusion.

- Since pleuritic chest pain has many possible causes, pericarditis should be diagnosed with caution in the absence of other clinical criteria, additionally a friction rub & ECG findings may be transient making the diagnosis even more challenging.

- Data from a recent RCT indicated that pericardial effusions are present in ~2/3 of patients; the vast majority are small and of no concern, nonetheless an echocardiogram is routinely indicated and if present should be carefully followed to assess for tamponade.

- Treatment for idiopathic/viral cases of pericarditis consistents of NSAIDs & colchicine.


LeWinter, MM. Acute Pericarditis. NEJM. Dec 18, 2014 Vol 371 No 25.