Pericarditis is inflammation of the pericardium, the sac around the heart. Most episodes are self-limiting or settle with anti-inflammatory treatment, and the topic is worth studying on its own for two reasons: pericarditis mimics ST-elevation myocardial infarction (STEMI, a heart attack in which an occluded coronary artery lifts the ST segment of the electrocardiogram), and a minority of episodes progress to cardiac tamponade (fluid under pressure compressing the heart) or constrictive pericarditis (a fibrotic, adherent pericardium that restricts the heart’s filling).
Pericarditis is a clinical diagnosis, not an echocardiographic one. The history, the physical examination and the electrocardiogram (ECG) establish it, and an echocardiogram (an ultrasound scan of the heart) that shows no pericardial effusion, meaning no excess fluid in the sac, does not exclude it. The reverse error matters too: an incidental effusion in a patient with no pain and no electrocardiographic changes is not pericarditis, and the causes to consider are a different set. Most of the judgement in this topic lies in deciding what an episode is and whether something more dangerous is developing underneath it, because the treatment of an uncomplicated episode is much the same for most patients.
Choose a route through this topic
The topic runs from recognising an episode, through treating it, to the two complications that can follow. A reader new to it can start with the clinical picture and continue in order; a reader with a specific question can go straight to the matching note.
- Pericarditis: Classification and Clinical Picture: the structure and functions of the pericardium, the seven groups of causes and how often no cause is found, and the pain, friction rub and fever that raise the diagnosis.
- Pericarditis: ECG and Diagnosis: the four ECG stages, how the elevated ST segment is separated from ST-elevation infarction and early repolarisation, the four clinical criteria, and the blood tests, imaging and fluid analysis that follow.
- Pericarditis: Management and Risk Stratification: the anti-inflammatory regimen with doses and tapering rules, treatment directed at the cause, recurrent pericarditis, and the features that decide who needs hospital care.
- Pericarditis: Pericardial Effusion and Tamponade: how fast fluid accumulates and how much the pericardium can stretch decide whether the heart is compressed, what an effusion is made of, the signs of tamponade, and how the fluid is drained.
- Constrictive Pericarditis: the fibrotic, adherent pericardium that restricts filling, its right-heart presentation, the imaging and catheter findings that confirm it, and how it is told apart from restrictive cardiomyopathy.
Acute Myocardial Infarction is the critical differential for pericardial chest pain, and pericardial inflammation also appears after infarction, as early post-infarct pericarditis or Dressler syndrome, in Complications of Myocardial Infarction. The constrictive form of pericardial disease is confused with restrictive physiology, which is one of the threads running through the cardiomyopathies.