🫀 Acute Pericarditis Diagnosis (ESC 2015)
ESC 2015 clinical criteria diagnose acute pericarditis and flag high-risk features warranting admission.
Clinical takeaway
Colchicine added to ASA/NSAID reduces recurrence and is part of standard first-line therapy (original synthesis · not guideline verbatim).
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When to use
Use to apply the ≥ 2/4 criteria, identify high-risk features, and direct anti-inflammatory therapy and disposition.
How it works
Diagnosis with ≥ 2 of: pericarditic chest pain, friction rub, ECG (widespread ST elevation/PR depression), pericardial effusion. High-risk features (fever > 38℃, large effusion, tamponade, NSAID failure, etc.) favor admission. Treatment: ASA/NSAID + colchicine.
Key points
- Colchicine added to ASA/NSAID reduces recurrence and is part of standard first-line therapy (original synthesis · not guideline verbatim).
- Corticosteroids are avoided first-line in idiopathic/viral pericarditis because they increase recurrence.
- Troponin should be checked to detect myopericardial involvement, which changes risk and management.
References
- Adler Y, et al. 2015 ESC pericardial diseases guideline. Eur Heart J 2015.
- Imazio M, et al. ICAP trial (colchicine). N Engl J Med 2013.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Pericarditic chest pain (sharp/pleuritic, relieved by sitting forward) | No |
|---|---|
| Pericardial friction rub | No |
| ECG: new widespread ST elevation or PR depression | No |
| New/worsening pericardial effusion | No |
| High-risk features (fever > 38℃/subacute onset/large effusion/tamponade/no response to NSAID after 1 week; or myocardial involvement/immunosuppression/trauma/oral anticoagulation) | None |
→Acute pericarditisCriteria not met (0/4)
- Criteria count：0/4 (chest pain/rub/ECG/effusion) → < 2, clinical diagnosis not met
- Supporting tests：Elevated inflammatory markers (CRP/ESR/WBC), CT/CMR showing pericardial inflammation support the diagnosis; recommended initial four: ECG, transthoracic echo, chest X-ray, inflammatory markers + troponin (to assess myocardial involvement)
- Risk stratification：No high-risk features → most can be managed as outpatients with empiric anti-inflammatory therapy and follow-up
| Pericarditic chest pain (sharp/pleuritic, relieved by sitting forward) | Yes |
|---|---|
| Pericardial friction rub | Yes |
| ECG: new widespread ST elevation or PR depression | Yes |
| New/worsening pericardial effusion | Yes |
| High-risk features (fever > 38℃/subacute onset/large effusion/tamponade/no response to NSAID after 1 week; or myocardial involvement/immunosuppression/trauma/oral anticoagulation) | Any present |
→Acute pericarditisDiagnosis met (≥ 2/4)
- Criteria count：4/4 (chest pain/rub/ECG/effusion) → ≥ 2, diagnosis met
- Supporting tests：Elevated inflammatory markers (CRP/ESR/WBC), CT/CMR showing pericardial inflammation support the diagnosis; recommended initial four: ECG, transthoracic echo, chest X-ray, inflammatory markers + troponin (to assess myocardial involvement)
- Risk stratification：High-risk features present → recommend admission, investigate etiology (beware bacterial/neoplastic/systemic disease)
Frequently asked questions
- What is Acute Pericarditis Diagnosis (ESC 2015)?
- ESC 2015 clinical criteria diagnose acute pericarditis and flag high-risk features warranting admission.
- How is Acute Pericarditis Diagnosis (ESC 2015) calculated? What is the core formula?
- Diagnosis with ≥ 2 of: pericarditic chest pain, friction rub, ECG (widespread ST elevation/PR depression), pericardial effusion. High-risk features (fever > 38℃, large effusion, tamponade, NSAID failure, etc.) favor admission. Treatment: ASA/NSAID + colchicine.
- When is Acute Pericarditis Diagnosis (ESC 2015) used?
- Use to apply the ≥ 2/4 criteria, identify high-risk features, and direct anti-inflammatory therapy and disposition.
- What are the key clinical points for Acute Pericarditis Diagnosis (ESC 2015)?
- Colchicine added to ASA/NSAID reduces recurrence and is part of standard first-line therapy (original synthesis · not guideline verbatim). Corticosteroids are avoided first-line in idiopathic/viral pericarditis because they increase recurrence. Troponin should be checked to detect myopericardial involvement, which changes risk and management.
- What are the limits and cautions when using Acute Pericarditis Diagnosis (ESC 2015)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Acute Pericarditis Diagnosis (ESC 2015) calculated in practice? Can you show a worked example?
- Inputs: Pericarditic chest pain (sharp/pleuritic, relieved by sitting forward) No, Pericardial friction rub No, ECG: new widespread ST elevation or PR depression No, New/worsening pericardial effusion No, High-risk features (fever > 38℃/subacute onset/large effusion/tamponade/no response to NSAID after 1 week; or myocardial involvement/immunosuppression/trauma/oral anticoagulation) None → Result: Acute pericarditis Criteria not met (0/4)（Criteria count: 0/4 (chest pain/rub/ECG/effusion) → < 2, clinical diagnosis not met, Supporting tests: Elevated inflammatory markers (CRP/ESR/WBC), CT/CMR showing pericardial inflammation support the diagnosis; recommended initial four: ECG, transthoracic echo, chest X-ray, inflammatory markers + troponin (to assess myocardial involvement), Risk stratification: No high-risk features → most can be managed as outpatients with empiric anti-inflammatory therapy and follow-up） Inputs: Pericarditic chest pain (sharp/pleuritic, relieved by sitting forward) Yes, Pericardial friction rub Yes, ECG: new widespread ST elevation or PR depression Yes, New/worsening pericardial effusion Yes, High-risk features (fever > 38℃/subacute onset/large effusion/tamponade/no response to NSAID after 1 week; or myocardial involvement/immunosuppression/trauma/oral anticoagulation) Any present → Result: Acute pericarditis Diagnosis met (≥ 2/4)（Criteria count: 4/4 (chest pain/rub/ECG/effusion) → ≥ 2, diagnosis met, Supporting tests: Elevated inflammatory markers (CRP/ESR/WBC), CT/CMR showing pericardial inflammation support the diagnosis; recommended initial four: ECG, transthoracic echo, chest X-ray, inflammatory markers + troponin (to assess myocardial involvement), Risk stratification: High-risk features present → recommend admission, investigate etiology (beware bacterial/neoplastic/systemic disease)）