Acute Pericarditis — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Diagnosis & risk stratification
   Meets diagnostic criteria (≥2 of 4)? Any high-risk features? (Pericardial inflammation (viral/idiopathic most common; tuberculosis is an important cause in some regions; also uremia, malignancy, autoimmune, post-MI). Diagnosis ≥2 of 4: 1) pleuritic chest pain (relieved by leaning forward, worse supine/inspiration, may radiate to trapezius) 2) pericardial friction rub 3) ECG widespread concave ST-elevation + PR depression (reciprocal in aVR) 4) new/worsening pericardial effusion. Add CRP/ESR, troponin (myopericarditis), echo, CXR. Must exclude ACS/dissection/PE.)
   • High-risk features → High-risk → admit & evaluate
   • Low-risk (typical, no high-risk) → Low-risk · NSAIDs + colchicine
2. [End] Low-risk · NSAIDs + colchicine
   Typical presentation, no high-risk features: outpatient first-line — NSAIDs (ibuprofen or aspirin; use aspirin post-MI) + colchicine (reduces recurrence, ~3 months); add a PPI for gastric protection; restrict exercise until resolution. Steroids are not first-line (increase recurrence; second-line only, or NSAID/colchicine contraindication or specific cause). Treat the underlying cause.
3. [End] High-risk → admit & evaluate
   High-risk features (fever >38°C, subacute, large effusion >20 mm or tamponade, immunosuppression, anticoagulation, trauma, raised troponin [myopericarditis], no response to NSAIDs at 1 week): admit and evaluate the cause; echo to exclude tamponade (tamponade → pericardiocentesis); on top of NSAIDs + colchicine, manage by cause (drain purulent, anti-TB therapy, etc.); for raised troponin, restrict activity as myopericarditis and obtain cardiology assessment.

Source guidelines & references

• ESC Guidelines on pericardial diseases; AAFP acute pericarditis

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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