The diagnosis is clinical and can be made based on following signs and symptoms:
pericardial (sharp central) chest pain - pleuritic, worse in the supine position or upon inspiration
pericardial friction rub upon auscultation
pericardial effusion (new or worsening)
low-grade intermittent fever
dyspnoea, cough, malaise, myalgia
Stage 1 – diffuse concave ST elevation and PR depression in all leads (reciprocal ST depression and PR elevation in aVR)
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks)
Stage 3 – flattened T waves become inverted (3 to several weeks)
Stage 4 – ECG returns to normal or persistence of T-wave inversions (several weeks onwards)
Sinus tachycardia is also common in acute pericarditis due to pain and/or pericardial effusion.
Downsloping TP segment seen as an early ECG manifestation in ~80% of patients with pericarditis, best visualised in leads II and the lateral precordial leads.
Pericarditis vs. STEMI
STE in pericarditis are concave; in AMI - convex or horizontal
STE in pericarditis - diffuse; in AMI - localised
Pericarditis - PR depression; AMI - Q waves
Pericarditis - inversion of T waves appear after normalising of ST segment; AMI - T wave inversion appears with STE
First line therapy
aspirin (500–1000 mg every 6–8 hours; range 1,5–4 g/day
ibuprofen (600 mg every 8 hours; range 1200–2400 mg)
Indomethacin (25–50 mg every 8 hours)
colchicine (0.5 mg twice or 0.5 mg daily for patients
Second line therapy (in case of contraindications to aspirin/NSAID/colchicine and after exclusion of infectious cause)
corticosteroids at low to moderate doses (i.e. prednisone 0.2–0.5 mg/kg/day)
I.v. immunoglobulin or anakinra or azathioprine in a recurrent pericarditis as a third line therapy.
Pericardiectomy in a recurrent pericarditis as a fourth line therapy.
ECG 1 Pericarditis (ST elevations I, II, aVL, aVF, V4-V6 + PR depression mainly seen in I, II, aVF)
ECG 2 Pericarditis - widespread ST elevations
Masek, Kevin P, and Joel T Levis. “ECG diagnosis: acute pericarditis.” The Permanente journal vol. 17,4 (2013): e146. doi:10.7812/TPP/13-044
Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristic AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W; ESC Scientific Document Group. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015 Nov 7;36(42):2921-2964. doi: 10.1093/eurheartj/ehv318. Epub 2015 Aug 29. PMID: 26320112; PMCID: PMC7539677.