Understanding Acute Pericarditis: Symptoms and Diagnosis

Acute pericarditis accounts for approximately 5% of emergency visits in North America and Western Europe related to non-ischemic chest discomfort. Its defining symptom is sharp, pleuritic chest pain that worsens in the supine position, fulfilling the diagnosis if two of four criteria are present. Characteristic electrocardiogram (EKG) changes, such as widespread elevation and PR depression, are observed in about 50% of cases. Additionally, the presence of a new or worsening pericardial effusion and a pericardial friction rub can aid in diagnosis. The most common causes of acute pericarditis include post-viral infection or idiopathic origins in certain regions, while tuberculosis is prevalent in areas where it is endemic, often accompanied by symptoms like night sweats, fever, and weight loss. Tuberculosis pericarditis tends to manifest with constrictive physiology. The pericardial friction rub, a key diagnostic feature, can be detected by auscultation and has a distinctive scratchy quality, typically during atrial systole and early ventricular diastole. Its presence can be fleeting, highlighting the importance of careful examination during respiratory pauses.