History and exam
Key diagnostic factors
common
chest pain
This is the most common symptom and occurs in more than 85% of cases.[1] Pain is sharp, stabbing, pleuritic, or aching, and can mimic the pain of myocardial ischemia or infarction, particularly when dull or pressure-like. Trapezius ridge pain is more specific for pericardial pain. Almost all patients report relief of pain with sitting up or leaning forward. The pain is generally constant, not related to exertion, and poorly responsive to nitrates.[13][15]
pericardial rub
May be present in <33% of cases.[1] The rub, when present, is described as high-pitched or squeaky. It is heard best at the left sternal edge with the patient leaning forward at end-expiration.[12] The rub can come and go over hours, so the sensitivity is based upon the frequency of cardiac auscultation and it is important to examine patients with suspected pericarditis repeatedly.[14]
Other diagnostic factors
uncommon
myalgias
A prodrome of myalgias and malaise may be present with any cause of acute pericarditis, particularly in young adults.
signs of right-sided heart failure
Symptoms and signs of right-sided heart failure include fatigue, ankle edema, and, in severe cases, ascites.
Constrictive pericarditis should be suspected in a patient with unexplained right heart failure in whom there is a history of pericardial disease or predisposing pericardial injury even if the pericardial insult predates the clinical presentation by years.[40]
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