Acute Pericarditis

Diagnostic Framework

• Acute pericarditis is a clinical diagnosis.
• Confirm the diagnosis when at least 2 of the following 4 findings are present:
  • Typical pleuritic chest pain.
  • Pericardial friction rub.
  • Typical electrocardiographic changes.
  • New or worsening pericardial effusion.
• Typical electrocardiographic findings include diffuse concave ST-segment elevation and PR-segment depression.
• Do not diagnose pericarditis from a single isolated feature.

Risk Stratification and Disposition

• Admit patients with any high-risk feature:
  • Fever above 38 degrees C.
  • Subacute presentation.
  • Large pericardial effusion greater than 20 mm.
  • Cardiac tamponade.
  • No response to nonsteroidal anti-inflammatory drugs (NSAIDs) after 7 days.
• Cardiac tamponade requires immediate attention.
• Recurrent pericarditis, constrictive pericarditis, and myopericarditis require active surveillance.

Initial Treatment

• For eligible patients, use an NSAID plus colchicine with physical-activity restriction.
• Continue the NSAID until symptoms resolve and C-reactive protein (CRP) normalizes.
• Add colchicine unless contraindicated:
  • Body weight below 70 kg: 0.5 mg once daily.
  • Body weight at or above 70 kg: 0.5 mg twice daily.
  • Recommended acute-course duration: 3 months.
• The provided source states that colchicine significantly reduces recurrence risk.

Corticosteroids

• Avoid routine corticosteroid use because it increases recurrence risk.
• Reserve corticosteroids for specific indications, including:
  • Autoimmune disease.
  • Pregnancy-related situations.
  • NSAID contraindication.
  • Other specific clinical indications.

Activity, Follow-up, and Monitoring

• Advise against strenuous exercise.
• Resume activity after symptoms resolve, CRP normalizes, and inflammation resolves.
• Athletes should avoid competitive sport for at least 3 months.
• Follow-up may include symptom review, CRP or erythrocyte sedimentation rate (ESR), electrocardiography, and echocardiography when clinically indicated.
• Taper therapy according to clinical improvement and inflammatory markers, rather than a fixed calendar.

Clinical Takeaways and Limits

• Continue evaluating chest-pain presentations for other dangerous diagnoses.
• This framework reflects the provided local ESC-based source and does not replace individualized assessment, monitoring, or consultation.
• Modify management as needed for local protocols, contraindications, drug interactions, renal function, and pregnancy-specific considerations.

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