Cardiovascular

Acute Pericarditis

Acute pericarditis is inflammation of the pericardium causing sharp pleuritic and positional chest pain, with or without an effusion; diagnose it while excluding acute coronary and other life-threatening chest-pain causes, then risk-stratify for secondary disease, tamponade and myopericarditis.

Definition

Acute pericarditis is an inflammatory pericardial syndrome with onset over a short period, diagnosed clinically when at least two of characteristic pericarditic chest pain, a pericardial friction rub, typical widespread ECG changes or a new or worsening pericardial effusion are present.

First principles

Inflammation changes pain and the ECG

Inflammation of the pericardial layers produces sharp pleuritic pain that is worse lying flat and better sitting forward, and may cause a transient friction rub. Diffuse epicardial inflammation can produce widespread ST-segment elevation and PR depression rather than a single coronary territory, but ECG appearances overlap with acute coronary syndromes, so the pattern must be interpreted with symptoms, troponin and risk.

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