Diagnosis and treatment of pericarditis

### Learning objectives 1. Review the definitions, classification and aetiology of pericarditis. 2. Describe the clinical presentation, diagnostic criteria and work-up, laboratory and imaging findings of pericarditis. 3. Review and describe the contemporary medical, interventional and surgical therapies, the prevention and prognosis of pericarditis. ### Classification and definition Pericarditis is an inflammatory disease of the pericardium, which may have infectious or non-infectious causes, and is manifested by a combination or signs (ie, pericardial rubs, electrocardiographic changes and pericardial effusion), symptoms (mainly chest pain but possible additional symptoms such as dyspnoea) and usually elevation of markers of myocardial inflammation (ie, protein C reactive).1–6 A concomitant myocardial involvement has been described in about one-third of patients with acute pericarditis and it is due to overlapping aetiological agents for pericarditis and myocarditis. In clinical practice it is often detected by elevation of markers of myocardial lesion (ie, troponins) assessed for the differential diagnosis with an acute coronary syndrome. These cases usually with preserved left ventricular function are commonly labeled as myopericarditis.7 ,8 The disease may present as an isolated process or as a part of another disease with pericardial involvement (ie, systemic inflammatory disease and lung cancer) thus involving different medical specialties (ie, cardiology, internal medicine, rheumatology, oncology and nephrology).6 Specific terminology has been adopted in clinical studies as well as guidelines and reviews and will be briefly reviewed in order to promote standardised definitions. Acute pericarditis is the first attack of pericarditis, generally occurring with an acute onset of symptoms. Treatment of the episode generally lasts for 4–6 weeks, considering the attack dose and drug tapering. If the patient does not reach a remission and the disease lasts several weeks or months without a symptoms-free interval of 4–6 weeks, the term incessant pericarditis is adopted. If the disease reappears after a symptom-free interval of 4–6 weeks, the term recurrent or relapsing pericarditis is …