Back to Basics: Acute Pericarditis

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June 6, 2017 by jtreb

By: Josh Trebach


-Inflammation of the pericardium, the fibrous sac that contains the heart



-Up to 5% of ED visits for chest pain may be related to pericarditis

-Recognition of the disease is important because it can lead to devastating pathology such as cardiac tamponade or constrictive pericarditis

-May also be a clue to other pathology (malignancy, etc.)




-Viruses (Coxsackie virus, HIV)

-Bacteria (Staph, Strep, TB)

-Fungal (Histoplasma)

-Malignancy/Metastatic Disease

-Drugs (Procainamide, Hydralazine)



-Connective Tissue Disease


-Post-MI, Aortic Dissection



Clinical Features: 

-Chest pain that radiates to back/neck/left shoulder

-Pain may get worse with movement, inspiration, laying supine

-Classic “tripoding” position to relieve discomfort (sitting up and leaning forward)

-Can be associated with fever and shortness of breath

-Friction rub on auscultation



-History and Physical

-Classically “diffuse ST elevations” with PR depression

-Serial EKGs are useful to determine new (pathological) from normal (baseline)

-Chest x-ray may show enlarged cardiac silhouette

-Echocardiogram is particularly useful to determine the presence of pericardial effusion

-CBC/BUN/Cr/Thyroid studies/ESR/CK/Troponin





-Viral or idiopathic etiologies –> Ibuprofen or Colchicine

-Myocarditis, Uremia, Any Hemodynamics Instability, Enlarged cardiac silhouette of unclear etiology –> Admit is likely warranted




  1. Tintinalli, J. E., & Stapczynski, J. S. (2010). Tintinalli’s emergency medicine: A comprehensive study guide. New York: McGraw-Hill.
  2. Tingle L, Molina D, & Calvert C. Acute Pericarditis. Am Fam Physician.2007 Nov 15;76(10):1509-1514.
  3. EKG provided from

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