UMEM Educational Pearls

Category: Cardiology

Title: pericarditis--no so classic after all

Keywords: pericarditis (PubMed Search)

Posted: 7/12/2009 by Amal Mattu, MD (Updated: 10/21/2021)
Click here to contact Amal Mattu, MD

A recent study from Mayo evaluated 238 patients with acute pericarditis and found that the "classic" features of acute pericarditis that we learned about are actually not as common as we think:

1. Only 50% of patients reported that their pain was positional and 70% reported that their pain was pleuritic. On the other hand, 12% reported pain that was typical anginal in nature.

2. Only 35-45% of patients reported a recent history of a viral illness.

3. Only 15-25% of patients had a friction rub.

4. Further complicating matters was the presence of positive troponin levels in 13% of the patients.

In this study, 17% of patients were sent for PCI because the treating physicians diagnosed the patients as having an acute MI. This study highlights the importance of maintaining pericarditis in the DDx of any patients with chest pain, even when it "sounds like an MI," and also maintaining vigilance for atypical features of pericarditis.