For Patients & General Readers

Acute pericarditis is an inflammation of the sac surrounding your heart, called the pericardium. It often causes sharp chest pain that might feel worse when you lie down or breathe deeply. While usually not serious, it's important to get it checked by a doctor to rule out more severe conditions and get the right treatment.

Clinical Overview

Acute pericarditis is characterized by inflammation of the visceral and parietal pericardium, typically presenting with pleuritic chest pain, pericardial friction rub, and diffuse ST-segment elevation on ECG. Etiologies are diverse, with viral infections being the most common, but autoimmune, neoplastic, and iatrogenic causes must be considered.

Clinical Presentation

Sudden onset of sharp, pleuritic chest pain, often retrosternal or left-sided.
Pain characteristically worsens with inspiration and lying supine, and improves with sitting up and leaning forward.
May be associated with fever, cough, dyspnea, and myalgias.
Presence of a pericardial friction rub on cardiac auscultation.
Electrocardiographic changes, typically diffuse ST-segment elevation and PR depression.

Signs & Symptoms

Symptoms (Patient-Reported)

Sharp chest pain
Pain that worsens with breathing
Pain that worsens when lying down
Pain that improves when sitting up or leaning forward
Fever
Shortness of breath
Cough
Fatigue

Signs (Clinician-Observed)

Pericardial friction rub (a scratching or rustling sound heard with a stethoscope)
Tachycardia
Fever
Hypotension (in severe cases with tamponade)

Differential Diagnoses

Condition	Distinguishing Feature
Myocardial Infarction (MI)	MI pain is typically substernal, crushing, and may radiate to the arm or jaw; ECG changes are localized to specific coronary territories, and cardiac biomarkers (troponin) are elevated.
Pulmonary Embolism (PE)	PE pain is often pleuritic but may be associated with dyspnea, hemoptysis, and risk factors for VTE; ECG may show S1Q3T3 pattern or sinus tachycardia, but troponin is typically normal.
Aortic Dissection	Dissection pain is typically sudden, severe, tearing, and may radiate to the back; often associated with pulse deficits and mediastinal widening on CXR.
Pneumonia/Pleuritis	Pain is pleuritic and associated with cough, fever, and focal lung findings on examination and imaging.
Gastroesophageal Reflux Disease (GERD)	GERD pain is often burning, retrosternal, and related to meals; may improve with antacids and is not typically associated with pericardial friction rub or ECG changes.
Musculoskeletal Chest Pain	Pain is often localized, reproducible with palpation, and not associated with systemic symptoms or cardiac findings.

Red Flags — Seek Immediate Care

Hemodynamic instability (hypotension, shock)
Signs of cardiac tamponade (muffled heart sounds, jugular venous distension, pulsus paradoxus)
Persistent or worsening chest pain despite treatment
Suspected underlying malignancy or severe systemic illness

Key Investigations

Electrocardiogram (ECG): Diffuse ST-segment elevation and PR depression are characteristic.
Cardiac biomarkers (Troponin): To rule out myocardial infarction.
Echocardiogram: To assess for pericardial effusion and its hemodynamic significance (e.g., signs of tamponade).
Complete Blood Count (CBC) and Inflammatory markers (ESR, CRP): To assess for infection or inflammation.
Chest X-ray: May show cardiomegaly if a large pericardial effusion is present.

Management Overview

Treatment for acute pericarditis typically involves anti-inflammatory medications, such as NSAIDs (e.g., ibuprofen) or colchicine, to reduce inflammation. Corticosteroids may be used for refractory cases or specific etiologies. Management also includes addressing the underlying cause and monitoring for complications like cardiac tamponade.

Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. TruelyserMD does not replace clinical judgement.