5 points to remember about pericarditis and pericardial effusions

1.      A diagnosis of pericarditis involves 2 of the following: A history of characteristic chest pain (sharp and pleuritic), pericardial friction rub (<30% of cases); ECG changes (diffuse ST elevation/PR depression) and a pericardial effusion (generally small). Check for an elevated CRP/ESR, especially for the inflammatory subtype.

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2.      Patients should be treated with a tapering course of anti-inflammatories (ASA or NSAIDS) and colchicine for 3 months to prevent recurrence. New drugs that are used for complicated/chronic inflammatory pericarditis include IL-1 blockers (anakinra, rilonacept). Older immune modulators like  azathioprine and steroids (very slow taper) are still useful. Remind patients to avoid strenuous exercise during the acute phase.

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3.      Only a minority of cases of pericarditis need to be hospitalized. Factors associated with poor prognosis include fevers (suspected bacterial etiology), subacute course, large pericardial effusions/tamponade, and failure to respond quickly to therapy.

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4.      Pericardial effusions are often an incidental finding on imaging.  Etiologies requiring attention include neoplastic, infectious (bacterial, TB), traumatic, aortic dissection, post surgical/procedural and post MI. Most cases of incidentally found pericardial effusions do not require admission.

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5.      The long-term prognosis for pericarditis/incidentally found pericardial effusions is favorable.  Uncommon sequelae include constrictive pericarditis, tamponade and effusive constrictive syndromes.  Definitive management rarely involves pericardiectomy.