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Air Force at large. Imazio M, Trinchero R. Current and future treatment for pericarditis. Future Cardiol. Ariyarajah V, Spodick DH.

Lotrionte M, et al. International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences.

Am Heart J. Imazio M, et al. Indicators of poor prognosis of acute pericarditis. Controversial issues in the management of pericardial diseases. Triage and management of acute pericarditis. Int J Cardiol. Guidelines on the diagnosis and management of pericardial diseases executive summary: Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology.

Eur Heart J. Spodick DH. Pericardial disease. Philadelphia, Pa. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol.

Zayas R, et al. Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol. The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria. Marinella MA. Electrocardiographic manifestations and differential diagnosis of acute pericarditis. Am Fam Physician. Diagnostic issues in the clinical management of pericarditis.

Int J Clin Pract. Prevalence of C-reactive protein elevation and time course of normalization in acute pericarditis: implications for the diagnosis, therapy, and prognosis of pericarditis. Bonnefoy E, et al. Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis.

Cardiac troponin I in acute pericarditis. Cheitlin MD, et al. Developed in collaboration with the American Society of Echocardiography. Permanyer-Miralda G. Acute pericardial disease: approach to the aetiologic diagnosis. Hoey ET, et al. Cardiovascular MRI for assessment of infectious and inflammatory conditions of the heart.

Medical therapy of pericardial diseases: part I: idiopathic and infectious pericarditis. J Cardiovasc Med Hagerstown. A randomized trial of colchicine for acute pericarditis. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

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Apr 1, Issue. Acute Pericarditis: Diagnosis and Management. Author disclosure: No relevant financial affiliations. C 2 , 7 , 15 Transthoracic echocardiography should be performed in all patients with suspected acute pericarditis to exclude pericardial effusion and cardiac tamponade. C 19 Patients with acute pericarditis should be treated empirically with nonsteroidal anti-inflammatory drugs.

C 7 Colchicine may be used as monotherapy or in combination with a nonsteroidal anti-inflammatory drug for the first episode of acute pericarditis. Enlarge Print Table 1. Table 1.

Enlarge Print Table 2. Table 2. Enlarge Print Table 3. Table 3. Enlarge Print Table 4. Table 4. Acute Pericarditis Electrocardiographic Changes Figure 1. Enlarge Print Table 5. Table 5. Diagnosis and Treatment of Acute Pericarditis Figure 2. Read the full article. Get immediate access, anytime, anywhere.

Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article. Evidence suggestive of cardiac tamponade. Large pericardial effusion an echo-free space greater than 20 mm.

Nonsteroidal anti-inflammatory drug therapy ineffective after seven days. Immunosuppressed state. History of oral anticoagulant therapy. Elevated cardiac troponin level suggestive of myopericarditis. Aortic dissection with leakage into pericardial sac. Familial pericarditis. Hypersensitivity- or autoimmunity-related. Collagen vascular disease. Gastroesophageal reflux disease. Myocardial infarction. Less common. Chest pain. Anterior, posterior or lateral.

Minutes ischemia ; hours infarction. Sharp, stabbing, occasionally dull. Pressure-like, heavy, squeezing. Worse when patient is supine, improved when sitting up or leaning forward. Change with respiration. Worsened with inspiration. In phase with respiration absent when the patient is apneic. Jaw, neck, shoulder, one or both arms, trapezius ridge.

Jaw, neck, shoulder, one or both arms. Response to nitroglycerin. Physical examination. Absent unless pericarditis is present.

Moreover, patients affected by pericarditis can subsequently develop chronic or recurrent pericarditis, which is difficult to prevent.

This article reviews the latest on diagnosis, treatment and follow up of acute pericarditis. Pericardial disease can occur as an isolated entity - typically pericarditis, or a manifestation of a systemic disorder stemming from inflammatory diseases such as systemic lupus erythematosus, rheumatoid arthritis or cancer 1. Many cases of acute pericarditis are presumed to be viral in aetiology: viruses involved are echovirus and coxsackievirus A and B.

They may even be cytomegalovirus, influenza-, adeno- and herpes viruses or HIV - testing for specific viruses is not routine practice because determining the virus rarely has an impact on treatment.

Furthermore, this process is expensive. Acute idiopathic pericarditis usually affects young and otherwise healthy individuals. The typical complaint is chest pain, that is most often pleuritic exacerbated by inspiration.

Patients may note lessening of the pain when they lean forward or are in the upright position. The most difficult differential diagnosis is myocardial infarction MI. As in MI, chest pain can radiate to the neck, arms, or left shoulder; however, if pain radiates to one or both trapezius muscle ridges it is likely due to pericarditis because the phrenic nerve that innervates these muscles traverses the pericardium.

It is usually a high-pitched, scratchy or squeaky sound best heard at the left sternal border and consisting of 3 phases that correspond to the movement of the heart during 3 phases of the cardiac cycle: 1 atrial systole, 2 ventricular systole, and 3 rapid ventricular filling during early diastole.

However, some rubs are present in only one monophasic or two biphasic components of the cardiac cycle 2. The electrocardiogram ECG is the most important tool in the diagnosis of pericarditis. It may show sinustachycardia and widespread ST-segment elevation which has been considered the hallmark of acute pericarditis.

Nevertheless the pericardium is electrically silent. Thus, mixed myocardial and pericardial involvement is probably present in the majority of cases 3. The ST segment is usually coved upward and resembles the current of injury of acute transmural ischemia. The distinction between acute pericarditis and ischemia is not usually difficult because lead involvement is more extensive in pericarditis and prominent reciprocal ST-segment depression in ischemia, which usually is absent in pericarditis, shows.

PR-depression is another feature in the ECG of the patient with pericarditis. PR depression in any lead had a high sensitivity The combination of PR depressions in both precordial and limb leads had the most favourable predictive power to differentiate myopericarditis from STEMI positive Other mandatory checks besides auscultation and ECG according to the latest European guidelines on pericardial diseases are echocardiography to rule out effusion, concomitant heart disease or signs of myocarditis, blood work for inflammation markers and myocardial enzymes, and chest X-ray, for differential diagnostic purposes especially.

See Table 1 6. Patients with pericarditis can be safely managed on an outpatient basis without a thorough diagnostic evaluation unless a specific cause is suspected or in a case of high-risk features, or both. A targeted aetiological search should be directed to the most common cause on the basis of clinical background, epidemiological issues or specific presentations. In developed countries clinicians should rule out pericarditis related to a systemic disease as well as neoplastic, tuberculous, and purulent pericarditis 7.

Hospitalisation in acute pericarditis is usually not necessary unless the clinical picture suggests non-idiopathic causes or a hemodynamically compromised patient. Patients who are immunocompromised or anticoagulated should also be observed initially in the hospital 8.

Treatment is directed to resolving symptoms. Ibuprofen is preferred for its fewest side effects and favourable effect on coronary blood flow.

Depending on severity and response, mg every hrs may be initially required and can be continued for days or up to a couple of weeks. Gastrointestinal protection must be provided in all patients. Colchicine 0,5 mg bid added to an NSAID or as monotherapy is also effective and has been shown to prevent recurrences level of evidence B, class IIa indication.

A common mistake is to use a dose too low to be effective or to taper the dose off too rapidly. For tapering of prednisone, ibuprofen or colchicine should be introduced early class IIa, level of evidence B. Patients with acute pericarditis have a good prognosis in general but are prone in some degree to recurrences, especially during viral infections.

Patients with acute pericarditis should avoid strenuous activities as long as symptoms persist. Some advocate assessment of CRP at presentation and then weekly, with anti-inflammatory drugs prescribed until complete resolution of symptoms and normalisation of CRP 9. The acute stage lasts usually from days to a couple of weeks.