🫀 Acute Pericarditis Diagnosis (ESC 2025)
Use[Pending update] Some thresholds, grades and management recommendations on this page that conflict with curre…
Source2025 ESC Guidelines for the management of myocarditis and pericarditis (Schulz-Menger J, et al. Eur…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Corticosteroids are avoided first-line in idiopathic/viral pericarditis because they increase recurrence.
When to use
[Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text.
How it works
With a compatible clinical presentation, count additional criteria (pericardial rub, new PR depression or widespread ST-segment elevation, elevated CRP, new or worsening pericardial effusion, pericardial oedema and/or LGE on CMR): ≥ 2 definite, 1 possible, 0 or no compatible presentation not supported.
Key points
- Corticosteroids are avoided first-line in idiopathic/viral pericarditis because they increase recurrence.
- Troponin should be checked to detect myopericardial involvement, which changes risk and management.
- The pericardium is electrically silent; ECG changes (PR depression, widespread ST-segment elevation) imply concomitant myocardial inflammation, so evaluate for myocarditis and differentiate from STEMI.
References
- [Guideline / primary source]2025 ESC Guidelines for the management of myocarditis and pericarditis (Schulz-Menger J, et al. Eur Heart J 2025;46(40):3952–4041; doi:10.1093/eurheartj/ehaf192)
- [Guideline / primary source]Previous version: 2015 ESC Guidelines for the diagnosis and management of pericardial diseases (Adler Y, et al. Eur Heart J 2015; doi:10.1093/eurheartj/ehv318)
- Imazio M, et al. ICAP trial (colchicine). N Engl J Med 2013.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Clinical presentation (entry condition, not counted) | B Other presentation compatible with pericarditis (clinician-judged: atypical chest pain, dyspnoea in the elderly, AF or other supraventricular arrhythmia, right heart failure signs) |
|---|---|
| Pericardial friction rub | No |
| ECG: new PR depression or widespread ST-segment elevation | No |
| Elevated CRP | Yes |
| New or worsening pericardial effusion | No |
| CMR: pericardial oedema and/or LGE | Yes |
| High-risk features (list [Pending update]) | None |
→Acute pericarditisDefinite
- Classification (ESC 2025)：Acute pericarditis: definite (ESC 2025) — compatible clinical presentation with 2 additional criteria (≥2).
- Additional criteria：2/5 (rub/ECG/CRP/effusion/CMR)
- Note：Clinical presentation is atypical (clinician-judged); exclude acute coronary syndrome, pulmonary embolism, aortic dissection and similar conditions first.
| Clinical presentation (entry condition, not counted) | A Typical pericarditic chest pain (sharp/pleuritic, relieved by sitting forward, worse on inspiration/lying down) |
|---|---|
| Pericardial friction rub | No |
| ECG: new PR depression or widespread ST-segment elevation | No |
| Elevated CRP | No |
| New or worsening pericardial effusion | No |
| CMR: pericardial oedema and/or LGE | No |
| High-risk features (list [Pending update]) | None |
→Acute pericarditisNot supported
- Classification (ESC 2025)：Acute pericarditis: not supported (ESC 2025) — a compatible clinical presentation plus at least 1 additional criterion is not met.
- Additional criteria：0/5 (rub/ECG/CRP/effusion/CMR)
- Risk stratification：→ most can be managed as outpatients with empiric anti-inflammatory therapy and follow-up
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Acute Pericarditis Diagnosis (ESC 2025)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Acute Pericarditis Diagnosis (ESC 2025) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Acute Pericarditis Diagnosis (ESC 2025) calculated in practice? Can you show a worked example?
- Inputs: Clinical presentation (entry condition, not counted) B Other presentation compatible with pericarditis (clinician-judged: atypical chest pain, dyspnoea in the elderly, AF or other supraventricular arrhythmia, right heart failure signs), Pericardial friction rub No, ECG: new PR depression or widespread ST-segment elevation No, Elevated CRP Yes, New or worsening pericardial effusion No, CMR: pericardial oedema and/or LGE Yes, High-risk features (list [Pending update]) None → Result: Acute pericarditis Definite（Classification (ESC 2025): Acute pericarditis: definite (ESC 2025) — compatible clinical presentation with 2 additional criteria (≥2)., Additional criteria: 2/5 (rub/ECG/CRP/effusion/CMR), Note: Clinical presentation is atypical (clinician-judged); exclude acute coronary syndrome, pulmonary embolism, aortic dissection and similar conditions first.） Inputs: Clinical presentation (entry condition, not counted) A Typical pericarditic chest pain (sharp/pleuritic, relieved by sitting forward, worse on inspiration/lying down), Pericardial friction rub No, ECG: new PR depression or widespread ST-segment elevation No, Elevated CRP No, New or worsening pericardial effusion No, CMR: pericardial oedema and/or LGE No, High-risk features (list [Pending update]) None → Result: Acute pericarditis Not supported（Classification (ESC 2025): Acute pericarditis: not supported (ESC 2025) — a compatible clinical presentation plus at least 1 additional criterion is not met., Additional criteria: 0/5 (rub/ECG/CRP/effusion/CMR), Risk stratification: → most can be managed as outpatients with empiric anti-inflammatory therapy and follow-up）