Pericarditis is an inflammation of pericardium, which can be an isolated disease or the first manifestation of underlying systemic disease.

Causes can be classified to infectious and non infectious. 

Infectious – mainly viral (enteroviruses, adenoviruses, Parvovirus B19, etc.); occasionally bacterial, fungal, TB

Non infectious - autoimmune, paraneoplastic syndrome, uraemia, Dressler’s syndrome, trauma, drug-induced

Clinical manifestation

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 

ECG manifestation 

  • 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.

Spodick’s sign

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

  1. STE in pericarditis are concave; in AMI - convex or horizontal
  2. STE in pericarditis - diffuse; in AMI - localised
  3. Pericarditis - PR depression; AMI - Q waves
  4. 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
  • exercise restriction

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


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