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.
Key red flags
Tachycardia, hypotension, raised JVP, pulsus paradoxus or echo chamber collapse requires emergency drainage assessment.
Investigation priorities
Support pericarditis and screen ACS/arrhythmia.
Management branches
Possible pericarditis.
- Assess ABCDE, ECG, troponin, CRP/FBC/U&E and urgent TTE; pursue ACS, PE or aortic imaging immediately when the phenotype warrants.
- Confirm at least two diagnostic criteria and document supportive inflammation; do not diagnose from positional pain alone.
Stable, no high-risk feature and no specific cause identified.
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.
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.