Acute Pericarditis: A Review of Current Diagnostic and Management Guidelines

Abstract

This review examined the relevance of chest pain, pericardial friction rub, pericardial effusion and ECG changes in regard to the diagnosis of acute pericarditis. It also assessed the evidence for the management and therapeutic guidelines, specifically nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids. Overall, there appears to be a lack of research into pericarditis. The bulk of high-quality research seems to have been carried out prior to the publication of the European Society of Cardiology guidelines of 2015. Diagnostically, the current combination of symptoms, clinical signs and investigations offer reasonable criteria for diagnosis, but they are not a gold standard. Research into its therapeutic treatment options is required to address the effects of specific nonsteroidal anti-inflammatory drugs (NSAIDs).

Primary Idiopathic Chylopericardium as Unusual Cause of Cardiac Tamponade

“…Signs and symptoms are not indicative of an underlying etiology [12] and chylopericardium may range from being asymptomatic [5,8,9] to having the clinical manifestations of a cardiac tamponade [12,21]. The most frequently described symptoms are cough, chest pain, dyspnea and fatigue [12,16,22] but in a recent literature review dyspnea was present in 53.90% followed by absent of symptoms (39.42%) and cough (10.58%) [1].…”

“…The combination of thoracic duct ligation and a pericardial window seems to be the most effective procedure to prevent recurrence [1,4,5].…”

“…However, chylopericardium is a rare cause of this syndrome [2] and it is important emphasize that it must be suspected related the clinical setting [3]. Considering that constrictive pericarditis and/or cardiac tamponade could be life threatening conditions it is important to act as soon as the diagnosis it is made [4][5][6].…”

PR depression with multilead ST elevation and ST depression in aVR by left circumflex artery occlusion: How to differentiate from acute pericarditis

“…PR-segment depression with multilead ST-segment elevation and STsegment depression in lead aVR is a typical ECG presentation in acute pericarditis (McNamara, Ibrahim, Satti, Ibrahim, & Kiernan, 2019).…”

“…PR‐segment depression with multilead ST‐segment elevation and ST‐segment depression in lead aVR is a typical ECG presentation in acute pericarditis (McNamara, Ibrahim, Satti, Ibrahim, & Kiernan, 6). In patients with STEMI, the ST‐segment elevation is found in leads overlying the transmural ischemic region, and reciprocal ST‐segment depression is often found in leads related to distant nonischemic regions (Kudenchuk, Maynard, & Cobb, 4).…”