Understanding Acute Pericarditis: Symptoms and Diagnosis

Acute pericarditis accounts for approximately 5% of emergency visits due to non-ischemic chest discomfort in North America and Western Europe. Typical symptoms include sharp, pleuritic chest pain that worsens when the patient is supine, making chest pain a defining characteristic for diagnosis. Diagnosis is confirmed when two of four key features are present, including characteristic EKG changes, which show widespread elevation and PR depression in up to 50% of cases. Additionally, patients may experience a new or worsening pericardial effusion, and a pericardial friction rub may be present, although it's not always detectable. The most common causes of acute pericarditis include viral infections or idiopathic origins, whereas in regions with high rates of tuberculosis, TB is the prevalent cause. Tuberculosis pericarditis presents differently, with patients often experiencing symptoms such as night sweats, fevers, and weight loss before chest pain, and is more likely to manifest with constrictive pathophysiology. A pericardial friction rub, characteristic of pericarditis, has a distinctive scratchy quality corresponding to the cardiac cycle's events, though it may be transient and not present in every case. Proper auscultation techniques, such as having the patient lean forward and using specific breathing patterns during examination, increase the chances of detecting this rub, which is a key indicator of pericarditis.