PERICARDITIS

✓ Medically ReviewedDISEASEID: MDBT0055🚨 TRIAGE: URGENTICD-10: I30.9

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Definition

CLINICAL DEFINITION

Pericarditis is inflammation of the pericardium (sac around the heart). Diagnosis needs two of four criteria (diagnostic rules). Criteria are pleuritic pain (sharp pain worse breathing), rub (scratchy heart sound), ECG shifts and effusion (fluid around heart). CRP (inflammation marker) and echocardiography (heart ultrasound) support assessment.

IN PLAIN ENGLISH

Pericarditis means the sac around the heart is swollen. It causes sharp pain that is worse breathing in or lying flat. Sitting forward often eases the pain. Doctors check heart tracing, heart ultrasound and blood tests for swelling.

COMMON MISCONCEPTION / WHAT IT DOES NOT MEAN

Pericarditis is not myocardial infarction (heart attack from blocked artery). Infarction shows regional ECG shifts with troponin (injury marker) rise. It is not myocarditis (muscle inflammation) alone, though overlap occurs. Effusion (fluid) and tamponade (compression) are complications, not synonyms.

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Word Breakdown

peri-

=around

cardi-

=heart

-itis

=inflammation

Literal Meaning: inflammation around the heart

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Abbreviations

ECG=Electrocardiogram - heart electrical tracing

CRP=C-reactive protein - inflammation blood marker

NSAID=Nonsteroidal anti-inflammatory drug - pain reliever

MI=Myocardial infarction - heart attack from blocked artery

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Synonyms & Variants

Acute pericarditis›Pericardial inflammation›Fibrinous pericarditis›

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Category-Specific Context

Pericarditis is a Disease because it is acquired pericardial inflammation (sac immune response) with course and complications. Course spans acute (under 4 weeks), incessant (over 4 weeks), recurrent (return after pause) and chronic (over 3 months). Care targets cause, inflammation and tamponade (compression) or constriction (stiff sac) watch.

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Clinical Context & Usage

CLINICAL SETTINGS

Emergency DepartmentCardiology WardAcute Medical UnitPrimary Care for follow-upInfectious Diseases Unit

USAGE & DOCUMENTATION NOTES

Use pericarditis only when diagnostic criteria (2 of 4 rules) are met, not for isolated pain. Record pain character, positional relief, rub (scratchy sound), ECG pattern, effusion (fluid) size and CRP (inflammation marker). State cause and course such as acute, recurrent or constrictive. Reassess early because tamponade (compression emergency) can evolve.

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Primary Causes & Pathophysiology

PATHOPHYSIOLOGY

Most cases start with viral trigger (germ insult) or immune activation (defence response). Inflamed pericardium (sac lining) releases mediators (chemical signals) causing pain and fibrin (sticky protein) deposit. Fluid may gather as exudate (leaky inflammatory fluid) forming effusion. Large or rapid effusion raises sac pressure causing tamponade (heart compression). Healing may scar and stiffen the sac causing constriction.

PRIMARY CAUSES

Viral infection

Direct viral injury plus immune response inflames the sac

Post-myocardial infarction Dressler syndrome

Autoimmune reaction to heart necrosis (tissue death) attacks pericardium weeks later

Uraemia from kidney failure

Retained toxins plus inflammation irritate the pericardium

Autoimmune disease such as lupus or rheumatoid

Immune complexes deposit in pericardium and trigger inflammation

Tuberculosis

Granulomatous (lumpy immune) bacterial spread causes chronic sac inflammation

Neoplastic invasion from lung, breast or lymphoma

Tumour spread directly invades the pericardium

Bacterial infection

Blood spread or nearby pneumonia seeds pus-forming germs in the sac

Post-procedure injury after surgery or ablation

Trauma plus immune activation inflames the sac after intervention

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Drug-Induced Causes

💊 Procainamide ↗

Mechanism: Lupus-like autoimmunity (self attack) causing pericardial inflammation

→ Stop drug and treat with NSAID plus colchicine with specialist input

💊 Hydralazine ↗

Mechanism: Lupus-like immune activation causing serositis (lining inflammation)

→ Stop hydralazine and use anti-inflammatory therapy with monitoring

💊 Isoniazid ↗

Mechanism: Lupus-like reaction with autoantibodies inflaming the pericardium

→ Stop if implicated and switch tuberculosis therapy with specialist guidance

💊 Clozapine ↗

Mechanism: Hypersensitivity (allergy type) myopericarditis with eosinophil (allergy cell) inflammation

→ Stop clozapine urgently with cardiac monitoring and cardiology care

💊 Immune checkpoint inhibitors ↗

Mechanism: T-cell activation causing immune pericarditis, often with myocarditis

→ Hold therapy, give corticosteroids and involve oncology cardiology urgently

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Epidemiology

Prevalence:Pericarditis is an uncommon cause of chest pain overall. It forms a small share of emergency chest pain visits. Recurrence (repeat episodes) affects a minority without colchicine (preventive drug). Tuberculous (germ related) forms cluster in high burden settings.

Age Group:Pericarditis can occur at any age but peaks in young adults. Viral (germ related) and idiopathic (unknown cause) forms dominate in teens and adults. Uraemic (kidney failure) and neoplastic (cancer related) forms rise with age and comorbidity (coexisting illness).

Geographic Distribution:Pericarditis occurs worldwide in all regions. Viral and idiopathic (unknown cause) forms dominate where routine echo (heart ultrasound) and CRP (inflammation testing) are available. Tuberculous (germ related) pericarditis clusters where tuberculosis burden is high. Bacterial (pus-forming) disease is rare where timely antibiotics are accessible.

Red Flags & Triage ★

TRIAGE LEVEL

🚨 URGENT

DO NOT MISS — LIFE-THREATENING PRESENTATIONS

Cardiac tamponade with hypotension and distended neck veins
Purulent bacterial pericarditis with fever and toxic state
Tuberculous pericarditis with prolonged course and effusion
Myocardial infarction mimicking diffuse ECG shifts
Aortic dissection with tearing pain and pulse difference

URGENT EVALUATION TRIGGERS

Hypotension with distended neck veins and muffled heart sounds
Fast heart with breathlessness and low urine output
Pulsus paradoxus (pressure dip breathing in) on bedside check
Large effusion with tamponade signs on echo (heart ultrasound)
Fever with toxic appearance and high white cells
Worsening breathlessness, faint or new confusion

Contraindications & Precautions

CONTRAINDICATIONS

Do not use corticosteroids as first line because recurrence risk rises
Do not use NSAIDs with allergy, active bleeding or severe kidney injury
Do not use colchicine with severe liver disease or blocking drug interactions without specialist review

SPECIAL PRECAUTIONS

Use lowest effective NSAID dose with stomach protection when needed
Monitor CRP (inflammation marker), kidney function and effusion (fluid) size during therapy
Taper therapy slowly and restrict exertion until symptoms settle
Screen for tuberculosis, autoimmune disease and malignancy (cancer) when atypical

Complications

DOWNSTREAM CLINICAL COMPLICATIONS

Pericardial effusion
Cardiac tamponade
Recurrent pericarditis
Constrictive pericarditis
Myopericarditis with arrhythmia or heart failure

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Confused With (LASA & DDx) ★

LEXICAL (LASA) — SIMILAR NAMES

Peritonitis

Shares peri start but is belly lining infection, not heart sac inflammation

Pleuritis

Shares pleuritic pain wording but is lung lining inflammation without ECG rub or effusion

Endocarditis

Shares carditis ending but is valve infection with murmur and bacteraemia (germs in blood)

CLINICAL DIFFERENTIAL DIAGNOSES (DDx)

Myocardial infarction

Key Distinguishing Feature: Regional ST shifts with troponin (injury marker) rise, not diffuse PR dip

Myocarditis

Key Distinguishing Feature: Focal ECG shifts with pump weakness and higher troponin

Pulmonary embolism

Key Distinguishing Feature: Pleuritic pain with fast heart, low oxygen and clot on imaging

Pneumothorax

Key Distinguishing Feature: Sudden pleuritic pain with absent breath sounds and lung edge on X-ray

Gastro-oesophageal reflux

Key Distinguishing Feature: Burning reflux pain without rub, ECG shifts or effusion

Musculoskeletal pain

Key Distinguishing Feature: Chest wall tenderness reproduced by touch without systemic inflammation

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Clinical Pearls

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Diagnose on 2 of 4: pleuritic pain, rub, diffuse ST elevation with PR dip, effusion. CRP and echo then guide duration and activity limits.

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Add colchicine to NSAID to cut repeat risk and avoid steroids first line. Steroids raise relapse after taper, so reserve them for NSAID failure or autoimmune cause.

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A troponin rise suggests myopericarditis (muscle plus sac involvement). Arrange closer rhythm and pump review rather than MI (heart attack) pathway alone.

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Watch for tamponade: low pressure, full neck veins, muffled sounds and pulsus paradoxus. Arrange urgent echo and drainage readiness at once.

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Restrict strenuous exertion until pain, fever, ECG shifts and CRP settle. Taper drugs slowly and screen atypical cases for TB, autoimmune disease or cancer.

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Example Usage & SOAP

CLINICAL SENTENCE

""Young adult with sharp pain eased sitting forward shows diffuse ST elevation from acute pericarditis.""

IN A SOAP NOTE

S: 27-year-old with sharp pleuritic chest pain eased sitting forward, low fever. O: BP 114/70, HR 104, RR 20, Temp 38.0C, SpO2 98 percent on air, friction rub present, ECG diffuse ST elevation. A: Acute pericarditis with small effusion, no tamponade. P: NSAID plus colchicine, CRP and echo follow-up, exertion limits with safety net.

DIFFERENTIAL DIAGNOSIS CONTEXT

Pressure-like pain with exertion and troponin rise favours infarction (heart attack). Sharp pain eased sitting forward with diffuse PR dip favours pericarditis. Fast heart with low oxygen favours embolism (lung clot). Absent breath sounds favour pneumothorax (collapsed lung).

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Prognosis

SHORT-TERM OUTCOME

Most acute viral or idiopathic (unknown cause) cases resolve within weeks with treatment. NSAID (pain reliever) plus colchicine (anti-inflammation drug) shortens symptoms and lowers repeat risk. Tamponade (compression) or purulent (pus-forming) disease carries higher short term risk. Early echo (heart ultrasound) and follow-up catch worsening.

LONG-TERM PROGNOSIS

Long term outlook is good for viral or idiopathic (unknown cause) disease with proper therapy. Repeat episodes occur in a minority, mainly without colchicine. Constrictive (stiff sac) or tuberculous (germ related) disease has worse outcomes. Chronic inflammation may limit activity until treated.

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References & Coding

ICD-10 DIAGNOSTIC CODE

I30.9

LITERATURE CITATIONS & GUIDELINES

[1]ESC Guidelines for diagnosis and management of pericardial diseases 2015

[2]NICE CG95 Chest pain of recent onset

[3]American College of Cardiology pericarditis clinical guidance

MEDICAL DISCLAIMER — This content is intended for educational purposes and qualified healthcare professionals only. Always refer to current clinical diagnostic criteria, institutional protocols, and official guidelines. Medobo is not responsible for clinical decisions made based on this content.