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Cardiology

Acute Pericarditis

Inflammation of the pericardium causing sharp pleuritic chest pain, friction rub and diffuse ST elevation. Most often viral or idiopathic; risk of pericardial effusion and tamponade.

Last reviewed 12 Jul 2026 - MedicoMedics editorial team

Inflammation of the pericardium with effusion and potential tamponade

Aetiology & pathophysiology

Most cases idiopathic/viral (Coxsackie, echovirus, adenovirus). Others: bacterial (Staph, TB), autoimmune (SLE, RA), uraemia, post-MI (Dressler), post-radiation, malignancy, drug-induced. Inflammation of parietal and visceral pericardium; can produce serous, fibrinous, purulent or haemorrhagic effusion.

Sources: ESC 2015 Guidelines for Pericardial Diseases (Eur Heart J 2015;36:2921); NEJM 2014;371:2410 - Acute Pericarditis

Clinical presentation

Sudden retrosternal or precordial chest pain - sharp, worse on inspiration and lying flat, relieved by sitting forward. Pericardial friction rub (best at lower left sternal edge, patient leaning forward). Tamponade: hypotension, distended neck veins, muffled heart sounds (Beck triad), pulsus paradoxus >10 mmHg, Kussmaul sign.

Sources: ESC 2015 Guidelines for Pericardial Diseases (Eur Heart J 2015;36:2921); NEJM 2014;371:2410 - Acute Pericarditis

Diagnosis

Two of four: typical chest pain, pericardial rub, ECG changes (diffuse ST elevation with PR depression; reciprocal changes in aVR/V1), pericardial effusion on echo. Bloods: elevated CRP, WBC; troponin elevation suggests myopericarditis. Chest X-ray: enlarged cardiac silhouette with significant effusion (>250 mL).

Sources: ESC 2015 Guidelines for Pericardial Diseases (Eur Heart J 2015;36:2921); NEJM 2014;371:2410 - Acute Pericarditis

Management

NSAIDs (ibuprofen 600 mg q8h or high-dose aspirin post-MI) plus colchicine 0.5 mg BID for 3 months, tapered by CRP normalisation - reduces recurrence by ~50%. Restrict exercise until symptom-free and CRP normal. Treat underlying cause. Steroids reserved for autoimmune, uraemic or NSAID-refractory disease.

Sources: ESC 2015 Guidelines for Pericardial Diseases (Eur Heart J 2015;36:2921); NEJM 2014;371:2410 - Acute Pericarditis

Complications

Recurrent/incessant/chronic pericarditis, cardiac tamponade, constrictive pericarditis. Emergent tamponade requires pericardiocentesis; purulent pericarditis needs surgical drainage plus antibiotics; TB pericarditis requires anti-TB therapy plus steroids.

Sources: ESC 2015 Guidelines for Pericardial Diseases (Eur Heart J 2015;36:2921); NEJM 2014;371:2410 - Acute Pericarditis

Sample USMLE-style MCQs

Try 5 questions on this topic. Practice hundreds more free with a trial.

Question 1

Which ECG finding is characteristic of acute pericarditis?

Question 2

A patient with pericarditis develops hypotension, distended neck veins and muffled heart sounds. Next step?

Question 3

Which combination therapy reduces pericarditis recurrence?

Question 4

Which is the most common cause of acute pericarditis in developed countries?

Question 5

Which physical sign supports tamponade rather than isolated pericarditis?

References

Primary guidelines and peer-reviewed sources used for this entry. Reviewed 12 Jul 2026 by MedicoMedics editorial team.

Frequently asked

How does pericarditis pain differ from angina?

Pericarditis pain is sharp, pleuritic, positional (relieved sitting forward) and not exertional; angina is dull, exertional and not positional.

What is the role of colchicine?

Adding colchicine 0.5 mg BID for 3 months to NSAIDs approximately halves recurrence and shortens symptoms.

Why avoid steroids as first-line?

Steroids increase recurrence risk and are reserved for autoimmune, uraemic or NSAID-refractory pericarditis.

What defines cardiac tamponade?

Clinical syndrome of impaired cardiac filling with hypotension, elevated JVP, muffled heart sounds and pulsus paradoxus - confirmed by echocardiography.

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