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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Acute pericarditis

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Escalate

Hypotension, raised JVP, severe breathlessness, syncope, a rapidly enlarging effusion, sustained arrhythmia or new LV dysfunction needs emergency admission and immediate echo; do not delay ACS, PE or aortic-dissection assessment.

Synopsis

Confirm acute pericardial inflammation, exclude lethal chest-pain mimics, triage high-risk features and prescribe evidence-based anti-inflammatory treatment.

  • Diagnose acute pericarditis when at least two are present: typical pain, rub, new widespread ST/PR change, or new/worsening effusion.
  • CRP elevation and CT/CMR inflammation support but do not replace the clinical criteria.
  • Pain is usually sharp, pleuritic and better sitting forward; no pain description safely excludes ACS or PE.
  • Admit or investigate intensively when fever above 38°C, subacute onset, large effusion/tamponade, NSAID non-response, myocardial involvement, immunosuppression, trauma or anticoagulation is present.
  • For uncomplicated idiopathic/viral disease, aspirin or an NSAID plus colchicine is first-line, with gastroprotection and activity restriction.
  • A UK colchicine oral-solution SmPC licenses adjunct treatment of acute and recurrent pericarditis, but many tablet SmPCs do not list this indication; adjust or avoid treatment for renal-hepatic disease and major CYP3A4/P-gp interactions.
  • Troponin rise indicates myocardial involvement, not MI by default; assess LV function, coronary probability and arrhythmic risk.
  • Taper anti-inflammatory therapy according to symptoms and CRP; recurrence often follows inadequate treatment or rapid steroid taper.

Key red flags

Tamponade physiology

Tachycardia, hypotension, raised JVP, pulsus paradoxus or echo chamber collapse requires emergency drainage assessment.

Myocardial involvement

Troponin rise, ventricular dysfunction, heart-failure signs or ventricular arrhythmia requires admission and myocarditis-level evaluation.

Investigation priorities

01
12-lead ECG with serial comparisonFirst step

Support pericarditis and screen ACS/arrhythmia.

Management branches

Front doorAcute pleuritic chest pain

Possible pericarditis.

  1. Assess ABCDE, ECG, troponin, CRP/FBC/U&E and urgent TTE; pursue ACS, PE or aortic imaging immediately when the phenotype warrants.
  2. Confirm at least two diagnostic criteria and document supportive inflammation; do not diagnose from positional pain alone.
  3. Check fever, subacute course, effusion size/tamponade, NSAID response, troponin/LV function, immunosuppression, trauma and anticoagulants.
  4. Admit any major/minor risk feature or uncertain dangerous differential; otherwise arrange treatment and review within about one week.
Low riskUncomplicated idiopathic/viral pericarditis

Stable, no high-risk feature and no specific cause identified.

  1. Start ibuprofen or aspirin at anti-inflammatory dose plus colchicine and gastroprotection after renal, GI, bleeding, pregnancy and interaction checks.
  2. Restrict strenuous activity until symptoms, CRP, ECG and cardiac function have normalised; athletes need specialist return-to-sport review.
  3. Review at about one week for pain, temperature, CRP, adherence and effusion; escalate admission/imaging if non-responsive.

Key medicines

Ibuprofen600 mg orally three times daily for 1-2 weeks, then taper by about 200 mg per dose each week when pain has resolved and CRP normalised; maximum 2400 mg/day.Avoid/modify with active ulcer or bleeding, severe renal disease, decompensated HF, NSAID hypersensitivity and late pregnancy; review anticoagulants and cardiovascular risk.
Colchicine0.5 mg orally once daily if body weight is 70 kg or less, or 0.5 mg twice daily if over 70 kg, usually for 3 months in a first episode; no loading dose.In mild or moderate renal or hepatic impairment use 0.5 mg once daily; severe impairment is contraindicated. Do not combine with strong CYP3A4/P-gp inhibitors when renal or hepatic function is impaired, and reduce or interrupt treatment even with normal function according to the interacting medicine. Stop and assess diarrhoea, vomiting, cytopenia or myopathy.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • 2025 ESC Guidelines for myocarditis and pericarditisCurrent risk, imaging, therapy and activity framework.
  • ESC: Diagnosis of acute pericarditisTwo-of-four clinical diagnostic criteria.
  • ESC: Management of acute pericarditisAnti-inflammatory doses and follow-up.
  • Ibuprofen 600 mg SmPCUK dose ceiling and safety cautions.
  • Colchicine 250 micrograms/mL oral solution SmPCLicensed UK acute/recurrent pericarditis dose, duration, renal/hepatic adjustments and interaction safeguards.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom
Once symptom-free and CRP normal, taper NSAID/aspirin; complete colchicine for 3 months unless toxicity or contraindication intervenes.