📄 Definition
Pericarditis is inflammation of the pericardial sac. It can be acute or chronic and may lead to complications such as pericardial effusion or cardiac tamponade.
🧫 Causes – Mnemonic: VIRAL PERICARD
Viral (most common – Coxsackie, influenza, HIV)
Idiopathic (often presumed viral)
Rheumatic diseases (SLE, RA)
AMI (Dressler’s syndrome – autoimmune post-MI)
Lung malignancy or metastatic spread
Post-pericardiotomy
End-stage renal failure (uraemia)
Radiation therapy
Infections (TB, fungal)
Cancer
Autoimmune (sarcoid, scleroderma)
Reactions to drugs (e.g. hydralazine, isoniazid)
Drug-induced lupus
📋 Clinical Features – Mnemonic: PERCARD
Pleuritic chest pain (sharp, worse on inspiration/cough)
Eased by sitting up, worse lying flat
Rub – pericardial friction rub on auscultation
Cardiac tamponade signs if effusion severe
Arrhythmias (rare)
Raised CRP/ESR
Dyspnoea (if effusion present)
🔬 Investigations
🥇 First-Line
ECG – widespread ST elevation + PR depression (pathognomonic)
Bloods – FBC, CRP/ESR, U&Es, troponin, viral serology
CXR – cardiomegaly (if effusion)
🥈 Second-Line
Echocardiogram – assess for effusion/tamponade
MRI – pericardial inflammation, if diagnosis unclear
Autoimmune screen – ANA, RF if autoimmune suspected
TB testing – if clinically indicated
Management – Mnemonic: NSAID REST
NSAIDs – ibuprofen or aspirin (1st-line)
Steroids – if NSAIDs contraindicated or ineffective
Avoid exercise – rest until resolution
Indomethacin – alternative NSAID
Diagnose and treat underlying cause
Recurrence – consider colchicine (reduces relapse risk)
Echo to monitor for complications
Screen for autoimmune/TB if needed
Tamponade – urgent pericardiocentesis if present
⚠️ Complications – Mnemonic: TAPE
Tamponade
Arrhythmias
Pericardial effusion
Effusive-constrictive pericarditis / constrictive pericarditis
🔺 Last updated in line with NICE Clinical Knowledge Summary – Pericarditis
Published: January 2022 • Last updated: April 2023
Last reviewed: August 2025
✅ PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.