Pericarditis - Revision history

Danbot: Strip excess bold text

2026-03-22T09:24:14Z

Strip excess bold text

Danbot: Add MedicationDose SMW entries for aspirin, ibuprofen, colchicine, prednisone; doses verified against ESC 2015 pericarditis guidelines

2026-03-20T17:55:25Z

Add MedicationDose SMW entries for aspirin, ibuprofen, colchicine, prednisone; doses verified against ESC 2015 pericarditis guidelines

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 *[https://journalfeed.org/article-a-day/2020/differentiating-stemi-from-pericarditis Differentiating STEMI from Pericarditis.]
 *[http://www.emdocs.net/em3am-pericarditis/ emDocs - Pericarditis]
 ==See Also==

Masoodrm: /* Other Findings */

2023-06-26T18:19:08Z

Other Findings

← Older revision		Revision as of 18:19, 26 June 2023
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	**If (STE)/(T height) in V6 or I > 0.25, then it is likely pericarditis		**If (STE)/(T height) in V6 or I > 0.25, then it is likely pericarditis
	*If predominantly inferior STE, ST-depression in aVL is sensitive for STEMI<ref>Bischof JE, Worrall C, Thompson P, et al. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Am J Emerg Med. 2016; 34(2):149-154.</ref>		*If predominantly inferior STE, ST-depression in aVL is sensitive for STEMI<ref>Bischof JE, Worrall C, Thompson P, et al. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Am J Emerg Med. 2016; 34(2):149-154.</ref>
	*Spodick's sign~~, purportedly in ~80%~~ - ~~downsloping~~ TP segment, often best seen in lead II and lateral precordial leads<ref>Chaubey VK and Chhabra L. Spodick’s Sign: A Helpful Electrocardiographic Clue to the Diagnosis of Acute Pericarditis. Perm J. 2014 Winter; 18(1): e122.</ref>		*Spodick's sign- Downsloping of the TP segment; often best seen in lead II and lateral precordial leads<ref>Chaubey VK and Chhabra L. Spodick’s Sign: A Helpful Electrocardiographic Clue to the Diagnosis of Acute Pericarditis. Perm J. 2014 Winter; 18(1): e122.</ref>
			**Suggestive but not diagnostic for acute pericarditis
	[[File:ST-T ratio.jpg\|thumbnail]]		[[File:ST-T ratio.jpg\|thumbnail]]
	[[File:Spodick's_sign.JPG\|thumbnail\|Spodick's sign]]		[[File:Spodick's_sign.JPG\|thumbnail\|Spodick's sign]]

Rossdonaldson1: /* See Also */

2022-12-14T18:40:23Z

Rossdonaldson1: /* Classical Teachings with Caveats Below */

2022-12-14T18:39:57Z

Classical Teachings with Caveats Below

← Older revision		Revision as of 18:39, 14 December 2022
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	**PR-depression is often early and transient in pericarditis		**PR-depression is often early and transient in pericarditis
	**In [[STEMI]], PR-depression is associated with atrial injury, though usually not as marked as in viral pericarditis<ref>Wang K, Asinger RW, and Marriott HJL. ST-segment Elevation in Conditions Other than Acute Myocardial Infarction. N Engl J Med 2003;349:2128-35.</ref>		**In [[STEMI]], PR-depression is associated with atrial injury, though usually not as marked as in viral pericarditis<ref>Wang K, Asinger RW, and Marriott HJL. ST-segment Elevation in Conditions Other than Acute Myocardial Infarction. N Engl J Med 2003;349:2128-35.</ref>
	**PR-elevation in aVR may also be present in [[STEMI]] and is infrequently seen in constrictive pericarditis		**PR-elevation in aVR may also be present in [[STEMI]] and is infrequently seen in [[constrictive pericarditis]]

	====Other Findings====		====Other Findings====

Rossdonaldson1: /* Diagnostic Criteria for Acute PericarditisImazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015;314(14):1498–506. */

2022-04-23T10:54:25Z

Diagnostic Criteria for Acute PericarditisImazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015;314(14):1498–506.

← Older revision		Revision as of 10:54, 23 April 2022
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	==Evaluation==		==Evaluation==
	===Diagnostic Criteria for Acute Pericarditis<ref>Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015;314(14):1498–506.</ref>===		===Diagnostic Criteria for Acute Pericarditis<ref>Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015;314(14):1498–506.</ref>===
	*Need 2 of the following		*Need 2 of the following:
	**Chest pain (typically sharp and pleuritic, improved by sitting up and leaning forward)		**Chest pain (typically sharp and pleuritic, improved by sitting up and leaning forward)
	**Pericardial friction rub (best heard at the LSB, with pt leaning forward at end-expiration)		**Pericardial friction rub (best heard at the LSB, with pt leaning forward at end-expiration)

Rossdonaldson1: /* Background */

2022-04-23T10:53:50Z

Background

← Older revision		Revision as of 10:53, 23 April 2022
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	==Background==		==Background==
	[[File:Pericarditis.jpg\|thumbnail\|Pericarditis compared with normal pericardium]]		[[File:Pericarditis.jpg\|thumbnail\|Pericarditis compared with normal pericardium]]
			[[File:2004 Heart Wall.jpg\|thumb\|Anatomy of the pericardium.]]
	*Inflammation of the pericardium		*Inflammation of the pericardium

	===Etiology===		===Etiology===
	*Idiopathic (25-85%)		*Idiopathic (25-85%)

Rossdonaldson1: /* ECG */

2022-04-23T10:42:58Z

ECG

← Older revision		Revision as of 10:42, 23 April 2022
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	===ECG===		===ECG===
	[[File:ECG000026-2.~~jpg~~\|thumb\|Acute pericarditis with clear diffuse ST elevation and some PTa depression]]		[[File:ECG000026-2.png\|thumb\|Acute pericarditis with clear diffuse ST elevation and some PTa depression]]
	====Classical Teachings with Caveats Below====		====Classical Teachings with Caveats Below====
	*Must differentiate from [[STEMI]] (classical teachings are not specific enough to do that)		*Must differentiate from [[STEMI]] (classical teachings are not specific enough to do that)

Blsimpso: /* Work-Up */

2022-04-21T02:24:07Z

Work-Up

← Older revision		Revision as of 02:24, 21 April 2022
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	**[[Troponin]] elevation may indicate a concurrent [[myocarditis]] which predispose to risk of [[CHF]] or [[arrhythmias\|arrhythmia]]. <ref>LeWinter MM, et al. Clinical practice. Acute pericarditis. N Engl J Med. 2014 Dec 18;371(25):2410-6. PMID: 25517707.</ref>		**[[Troponin]] elevation may indicate a concurrent [[myocarditis]] which predispose to risk of [[CHF]] or [[arrhythmias\|arrhythmia]]. <ref>LeWinter MM, et al. Clinical practice. Acute pericarditis. N Engl J Med. 2014 Dec 18;371(25):2410-6. PMID: 25517707.</ref>
	*[[CXR]]		*[[CXR]]
			**Typically normal if no pericardial effusion.
			**Will not see increase in cardiac silhouette size until > 300mL of pericardial fluid has accumulated
	*Bedside Ultrasound to rule out effusion		*Bedside Ultrasound to rule out effusion
	**~2/3 of cases will have pericardial effusion<ref>LeWinter MM. Clinical practice. Acute pericarditis. N Engl J Med. 2014 Dec 18;371(25):2410-6. doi: 10.1056/NEJMcp1404070. Review. </ref>		**~2/3 of cases will have pericardial effusion<ref>LeWinter MM. Clinical practice. Acute pericarditis. N Engl J Med. 2014 Dec 18;371(25):2410-6. doi: 10.1056/NEJMcp1404070. Review. </ref>

Dcpinzonc: /* Initial Treatment */

2021-09-16T22:27:52Z

Initial Treatment

← Older revision		Revision as of 22:27, 16 September 2021
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	===Initial Treatment===		===Initial Treatment===
	*'''[[NSAIDS]] or [[Aspirin]]: '''first line treatment (in absence of contraindications) for viral or idiopathic pericarditis.<ref>Imazio M. A randomized trial of colchicine for acute pericarditis.N Engl J Med. 2013 Oct 17;369(16):1522-8 [http://www.nejm.org/doi/pdf/10.1056/NEJMoa1208536 PDF]</ref>		*'''[[NSAIDS]] or [[Aspirin]]: '''first line treatment (in absence of contraindications) for viral or idiopathic pericarditis.<ref>Imazio M. A randomized trial of colchicine for acute pericarditis.N Engl J Med. 2013 Oct 17;369(16):1522-8 [http://www.nejm.org/doi/pdf/10.1056/NEJMoa1208536 PDF]</ref>
	**[[Aspirin]] ~~800mg~~ every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks '''OR'''		**[[Aspirin]] 650mg every 6 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks '''OR'''
	**[[Ibuprofen]] 600mg every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks		**[[Ibuprofen]] 600mg every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks
	*'''[[Colchicine]]''' add to [[NSAIDs]] as first line treatment for viral/idiopathic acute and recurrent pericarditis to improve remission rates and prevent recurrence.<ref>ImazioM, BobbioM, Cecchi E, et al. Colchicine in addition to conventional therapy for acute pericarditis. Circulation. 2005;112(13):2012-2016.</ref>		*'''[[Colchicine]]''' add to [[NSAIDs]] as first line treatment for viral/idiopathic acute and recurrent pericarditis to improve remission rates and prevent recurrence.<ref>ImazioM, BobbioM, Cecchi E, et al. Colchicine in addition to conventional therapy for acute pericarditis. Circulation. 2005;112(13):2012-2016.</ref>

← Older revision		Revision as of 18:40, 14 December 2022
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	*[[STEMI]]		*[[STEMI]]
	*[[Myocardial infarction complications]]		*[[Myocardial infarction complications]]
	*[[~~In-Training Exam Review~~]]		*[[Constrictive pericarditis]]

	==References==		==References==

← Older revision		Revision as of 09:24, 22 March 2026
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	*Classically pericardidits has concave upwards STE		*Classically pericardidits has concave upwards STE
	**However, [[STEMI]] may have concave upwards ST-segment morphology as well		**However, [[STEMI]] may have concave upwards ST-segment morphology as well
	**Rather, it is ~~'''~~STE convex upwards or horizontal~~'''~~ that favors [[STEMI]]		**Rather, it is STE convex upwards or horizontal that favors [[STEMI]]
	*Classically pericardititis has PR-depression in ''viral pericarditis'' (or PR-elevation in AVR)		*Classically pericardititis has PR-depression in ''viral pericarditis'' (or PR-elevation in AVR)
	**Less reliable in post-MI patients and those with baseline ECG abnormalities		**Less reliable in post-MI patients and those with baseline ECG abnormalities
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	*Leads II and III		*Leads II and III
	**STE II > STE III favors pericarditis		**STE II > STE III favors pericarditis
	**~~'''~~STE III > STE II very strongly~~'''~~ favors [[STEMI]]		**STE III > STE II very strongly favors [[STEMI]]
	*STD not in aVR or V1 (reciprocol changes) suggestive of [[STEMI]]		*STD not in aVR or V1 (reciprocol changes) suggestive of [[STEMI]]
	*May see low voltage/alternans if effusion present		*May see low voltage/alternans if effusion present
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	==Management==		==Management==
	===Initial Treatment===		===Initial Treatment===
	*~~'''~~[[NSAIDS]] or [[Aspirin]]: ~~'''~~first line treatment (in absence of contraindications) for viral or idiopathic pericarditis.<ref>Imazio M. A randomized trial of colchicine for acute pericarditis.N Engl J Med. 2013 Oct 17;369(16):1522-8 [http://www.nejm.org/doi/pdf/10.1056/NEJMoa1208536 PDF]</ref>		*[[NSAIDS]] or [[Aspirin]]: first line treatment (in absence of contraindications) for viral or idiopathic pericarditis.<ref>Imazio M. A randomized trial of colchicine for acute pericarditis.N Engl J Med. 2013 Oct 17;369(16):1522-8 [http://www.nejm.org/doi/pdf/10.1056/NEJMoa1208536 PDF]</ref>
	**[[Aspirin]] 650mg every 6 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks ~~'''~~OR~~'''~~		**[[Aspirin]] 650mg every 6 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks OR
	**[[Ibuprofen]] 600mg every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks		**[[Ibuprofen]] 600mg every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks
	*~~'''~~[[Colchicine]]~~'''~~ add to [[NSAIDs]] as first line treatment for viral/idiopathic acute and recurrent pericarditis to improve remission rates and prevent recurrence.<ref>ImazioM, BobbioM, Cecchi E, et al. Colchicine in addition to conventional therapy for acute pericarditis. Circulation. 2005;112(13):2012-2016.</ref>		*[[Colchicine]] add to [[NSAIDs]] as first line treatment for viral/idiopathic acute and recurrent pericarditis to improve remission rates and prevent recurrence.<ref>ImazioM, BobbioM, Cecchi E, et al. Colchicine in addition to conventional therapy for acute pericarditis. Circulation. 2005;112(13):2012-2016.</ref>
	**Patients >70kg - 0.6mg PO BID x 3 months		**Patients >70kg - 0.6mg PO BID x 3 months
	**Patients<70kg - 0.6mg PO Daily x 3 months		**Patients<70kg - 0.6mg PO Daily x 3 months
	*~~'''~~[[Glucocorticoid]] therapy~~'''~~ second line agent for viral/idiopathic pericarditis, can consider low-moderate doses for patients with contraindications to [[NSAIDs]] or persistent symptoms despite appropriate therapy with NSAIDs + colchicine for at least 1 week. Also used for etiologies that are steroid responsive diseases.		*[[Glucocorticoid]] therapy second line agent for viral/idiopathic pericarditis, can consider low-moderate doses for patients with contraindications to [[NSAIDs]] or persistent symptoms despite appropriate therapy with NSAIDs + colchicine for at least 1 week. Also used for etiologies that are steroid responsive diseases.
	**[[Prednisone]] 0.2 to 0.5mg/kg of body weight per day for 2 weeks with gradual tapering<ref>Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for recurrent pericar- ditis: high versus low doses: a nonran- domized observation. Circulation 2008; 118:667-71.</ref>		**[[Prednisone]] 0.2 to 0.5mg/kg of body weight per day for 2 weeks with gradual tapering<ref>Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for recurrent pericar- ditis: high versus low doses: a nonran- domized observation. Circulation 2008; 118:667-71.</ref>

	===Recurrent or Refractory===		===Recurrent or Refractory===
	''For recurrent or refractory cases consider colchicine and or steroids although literature suggests it can be used as first line''<ref>Imazio M.Colchicine as first-choice therapy for recurrent pericarditis: results of the ~~C'''OR'''E~~ (Colchicine for REcurrent pericarditis) trial. Arch Intern Med. 2005 Sep 26;165(17):1987-91.</ref>		''For recurrent or refractory cases consider colchicine and or steroids although literature suggests it can be used as first line''<ref>Imazio M.Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (Colchicine for REcurrent pericarditis) trial. Arch Intern Med. 2005 Sep 26;165(17):1987-91.</ref>

	*~~'''~~[[Colchicine]]~~'''~~		*[[Colchicine]]
	**Patients >70kg - 0.6mg PO BID x 6 months		**Patients >70kg - 0.6mg PO BID x 6 months
	**Patients<70kg - 0.6mg PO Daily x 6 months		**Patients<70kg - 0.6mg PO Daily x 6 months