Chest pain, which may be intense, mimicking acute MI, but characteristically sharp, pleuritic, and positional (relieved by leaning forward); fever and palpitations are common. Typical pain may not be present in slowly developing pericarditis (e.g., tuberculous, post-irradiation, neoplastic, uremic).
Physical Examination
Rapid or irregular pulse, coarse pericardial friction rub, which may vary in intensity and is loudest with pt sitting forward.
Laboratory ECG
Diffuse ST elevation (concave upward) usually present in all leads except aVR and V1; PR-segment depression (and/or PR elevation in lead aVR) may be present; days later (unlike acute MI), ST returns to baseline and T-wave inversion develops. Atrial premature beats and atrial fibrillation may appear. Differentiate from ECG of early repolarization (ER) (ratio of ST elevation/T wave height <0.25 in ER, but >0.25 in pericarditis).
CXR
Symmetrically increased size of cardiac silhouette if large (>250 mL) pericardial effusion is present.
Echocardiogram
Most readily available test for detection of pericardial effusion, which commonly accompanies acute pericarditis.
Acute Pericarditis TREATMENT
Aspirin 650–975 mg qid or other NSAIDs (e.g., ibuprofen 400–600 mg tid or indomethacin 25–50 mg tid); addition of colchicine 0.6 mg bid may be beneficial and reduces frequency of recurrences. For severe, refractory pain, prednisone 40–80 mg/d can be used as last resort. Intractable, prolonged pain or frequently recurrent episodes may require pericardiectomy. Anticoagulants are relatively contraindicated in acute pericarditis because of risk of pericardial hemorrhage
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