Pericarditis

Clinical classification[1]Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015 Nov 7;36(42):2921-64. https://academic.oup.com/eurheartj/article/36/42/2921/2293375 http://www.ncbi.nlm.nih.gov/pubmed/26320112?tool=bestpractice.com

Pericarditis can be classified by duration of inflammation as well as by aetiology and complications/sequelae.

A. Acute pericarditis (new onset, <4-6 weeks)

• Inflammatory pericardial syndrome associated with at least 2 of the following 4 criteria:

  • Characteristic chest pain: typically sharp, pleuritic; relieved by sitting forwards and worsened by lying flat

  • Pericardial friction rub; 'like walking through crunchy snow'

  • New widespread diffuse concave upwards ST elevation or PR depression on ECG

  • New or worsening pericardial effusion.

• Additional supporting findings include:

  • Elevated inflammatory markers (i.e., C-reactive protein, erythrocyte sedimentation rate, white blood cell count)

  • Evidence of pericardial thickening/inflammation by advanced imaging techniques (i.e., cardiac computed tomography or magnetic resonance imaging).

• Can be associated with a pericardial effusion that is fibrinous or effusive (serous or serosanguinous).

B. Incessant pericarditis

• Signs and symptoms lasting >4 to 6 weeks but <3 months without remission.

C. Recurrent pericarditis

• Recurrence of signs and symptoms after an initial documented episode of acute pericarditis with an intervening symptom-free interval of ≥4 to 6 weeks.

D. Chronic pericarditis

• Signs and symptoms persisting for >3 months.

Subtypes:

• Constrictive (due to chronically thickened pericardium)

• Effusive-constrictive (combination of tense effusion in the pericardial space and constriction by the thickened pericardium)

• Adhesive (non-constrictive).