Pericarditis differential diagnosis

Pericarditis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
HIV
Post MI
Dressler's syndrome
Post-pericardiotomy
Radiation
Tuberculosis
Uremia
Malignancy
Differentiating Pericarditis from other Diseases
Epidemiology and Demographics
Screening
Natural History, Complications and Prognosis
Pericardial Effusion
Cardiac Tamponade
Constrictive Pericarditis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Pericardiocentesis
Pericardial Window
Pericardial Stripping
Treatment Related Videos
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Pericarditis differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Google Images
American Roentgen Ray Society Images of Pericarditis differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Pericarditis differential diagnosis
CDC on Pericarditis differential diagnosis
Pericarditis differential diagnosis in the news
Blogs on Pericarditis differential diagnosis
Directions to Hospitals Treating Type page name here
Risk calculators and risk factors for Pericarditis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

For a full discussion of the differential diagnosis of chest pain click here

For an expert algorithm that aids in the diagnosis of the cause of chest pain click here

Overview

Signs and symptoms of pericarditis may be similar to several other conditions including myocardial infarction, aortic dissection and pulmonary embolism which are life threatening and therefore it is important to differentiate them. Pain along the trapezius ridge, lasting long, being unresponsive to vasodilator therapy and varying with position are specific to pericarditis.

Differentiating Pericarditis from other Conditions

Several conditions, including life threatening conditions such as myocardial infarction, aortic dissection and pulmonary embolism produce signs and symptoms that are similar to those produced by pericarditis. Although the following features are not 100% sensitive and/or specific in distinguishing the different causes of chest pain, they are useful guides:

• Pain along the trapezius ridge(s), is very characteristic of pericarditis. The pain of myocardial infarction tends to involve the anterior precordium with either no radiation or radiation to either the jaw or the left arm.
• Unlike cardiac ischemia, the pain of pericarditis often lasts longer, and is unresponsive to vasodilator therapy.
• Ischemic chest pain is often described as a sense of "heaviness", "vice like", "pressure like", or like "an elephant sitting on the chest". The pain of pericarditis is often sharp and pleuritic (exacerbated by breathing in).
• Ischemic chest pain is generally not positional in nature whereas the pain of pericarditis is relieved by sitting up and bending forward and worsened by lying down (recumbent or supine position) or inspiration (taking a breath in)
• The EKG of pericarditis shows PR segment depression while the EKG of myocardial infarction does not (unless there is atrial infarction).
• The EKG of pericarditis shows ST elevation that does not necessarily follow the anatomic distribution of a single coronary artery.
• Other symptoms of pericarditis may include a viral prodrome including dry cough, fever, and fatigue.

These differentiating features are summarized in the table below

Characteristic/Parameter	Pericarditis	Myocardial infarction
Pain description	Sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain	Crushing, pressure-like, heavy pain. Described as "elephant on the chest."
Radiation	Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation.	Pain radiates to the jaw, or the left or arm, or does not radiate.
Exertion	Does not change the pain	Can increase the pain
Position	Pain is worse supine or upon inspiration (breathing in)	Not positional
Onset/duration	Sudden pain, that lasts for hours or sometimes days before a patient comes to the ER	Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the patient decides to come to the ER

Chest Pain Following Myocardial Infarction

It should be noted that ST elevation MI can also be associated with the subsequent development of pericarditis. In a patient with recurrent chest pain following acute MI, one is often left wondering whether the chest pain is due to reocclusion of the culprit artery, or if it is due to the early development of pericarditis, or if it occurs later, if it is due to Dressler's syndrome. Occlusion of the culprit artery or stent thrombosis should be associated with recurrent ST segment elevation in the appropriate anatomic ECG leads.