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2015 ESC Guidelines for the Diagnosis & Management of Pericardial Diseases

The following information provides simple, key information, using terminology that is more widely understood. The following information is designed to help patients understand diagnosis and treatment options recommended by the 2015 updates from the European Society of Cardiology (ESC) for pericarditis.

How do you find out if you have pericarditis?  

The diagnosis of acute pericarditis can be made with careful questioning, tests, and examination by a healthcare provider. A diagnosis usually includes at least 2 of the following: chest pain usually in the middle or left side of the chest, an extra heart sound heard during physical examination called a “pericardial rub,” changes in electrical activity of the heart found on an EKG/ECG (electrocardiogram), and new or an increase in the amount of fluid surrounding the heart.


Will hospitalization be needed?

In most cases, pericarditis can be treated outside of the hospital and will resolve on its own or with the use of over-the-counter medications. If a patient is thought to be at a higher risk of complications, close monitoring of the patient may be required.


Who is at high-risk?

Patients with fever (>38 C, >100.4 F), large amount of fluid found around the heart, fluid that is preventing the heart from working normally, or patients who do not respond to treatment within 1 week. Additional considerations may be made if the patient is on blood thinners, immunosuppressed, or trauma to the chest.


What testing may be done?

Blood test*: Used to check for specific signs of inflammation in the body.
Electrocardiogram (ECG/EKG)*: Painless test where stickers are placed on the skin on the chest and side.  Records the electric activity of the heart.
Chest X-Ray*: Painless test to look for changes in any organs or structures in the chest, specifically if the heart appears larger.
Echocardiogram (Echo)*: Ultrasound or radio waves that can be used to detect the pumping motion of the heart and look for fluid build-up.
Cardiac magnetic resonance imaging (CMR): Test using magnets used to give a more detailed picture of the heart and surrounding tissues. Can show swelling or inflammation of the heart or surrounding tissue. May be preferred in recurrent pericarditis.
Cardiac computerized tomography (CCT): Multiple X-rays taken from multiple angles that provide details of the heart in “slices” (cross sections) to look for thickening of the tissues surrounding the heart.
Positron emission tomography (PET): An imaging test that uses radioactive drug (tracer). May be used in cases of autoimmune disease or cancers.
Cardiac Catheterization: Not used often. A narrow tube is inserted into the heart vessels to check for blockages to ensure symptoms of chest pain are not actually a heart attack. Can also be used to check pressures inside of the heart to make sure the ability of the heart to pump appropriately is not at risk.

* Recommended to be completed for all patients when pericarditis is suspected.

What are the causes of Pericarditis?
  • Infectious cause. Viral Infection (common), bacterial, fungal (very rare), or parasites (very rare).
  • The body’s immune reaction after a heart attack, or heart surgery.
  • Inflammatory or autoimmune disorders including lupus and rheumatoid arthritis.
  • Injury to the heart or chest.
  • Cancer or previous radiation to the chest.
  • Kidney disease. May occur within the first weeks after starting dialysis.
  • Other causes include medication use and thyroid disorders.
What is the treatment for Pericarditis?

Treatment is dependent on the type of pericarditis:

  • Acute pericarditis:Begins suddenly but usually does not last longer than 6 weeks. Treatment is not always needed, and symptoms may go away on their own.
  • Incessant pericarditis:Lasts beyond four to six weeks without relief from symptoms.
  • Recurrent pericarditis:Symptoms that return after being symptom free for 4 to 6 weeks.
  • Chronic pericarditis:Symptoms that last longer than three months. Usually does not begin suddenly; symptoms come on more slowly and continue to increase over time.

*Additional medications such as antacids can be considered with the use of high dose NSAIDs to prevent stomach ulcers.

+ Only used if the first-line medications (NSAIDs) are not tolerated. Can not be used if infection suspected.

What are some complications of pericarditis?

Cardiac Tamponade: A medical emergency where the collection of fluid increases pressure around the heart and interferes with the ability for the heart to pump. This pressure can lead to a dangerous drop in blood pressure.
Constrictive Pericarditis: Usually seen as a long-term complication; the gradual hardening and thickening of the tissue surrounding the heart that can interfere with the ability for the heart to pump.

Other than medication, is any other type of treatment?

Pericardiocentesis: Sterile needle or tube is placed into the space between the heart and the lining to drain and remove excess fluid.
Pericardial Window: A surgical procedure where a small portion of the protective sac around the heart is removed to drain fluid. A tube may be kept in place to ensure that the excess fluid does not come back. The fluid removed can be evaluated for what may be causing the excess fluid.
Pericardiectomy: Surgical procedure that partly or fully removes the sac around the heart. Used as treatment for chronic pericarditis.  

 For more information and complete text of ESC guidelines