GP emergency management

A young woman with chest pain and ECG changes

Anthony Van Assche, Gordian Fulde



A woman presents with chest pain and her ECG suggests a diagnosis of pericarditis but acute myocardial infarction needs to be ruled out.

Key Points

  • Acute pericarditis is diagnosed by the presence of at least two of the following criteria: typical chest pain, pericardial friction rub, suggestive ECG changes, and new or worsening pericardial effusion.
  • Patients with suspected pericarditis and/or chest pain should be sent by ambulance to the emergency department of their local hospital to rule out acute coronary syndrome.
  • Echocardiography is still the gold-standard test for pericarditis.
  • The ECG changes in acute pericarditis differ from that of acute myocardial infarction in several ways.
  • Treatment of pericarditis depends on the underlying cause.
  • Indicators for poor prognosis in patients with pericarditis include temperature above 38oC, subacute onset over weeks, immunosuppression and large pericardial effusion.

    Picture credit: © iStockphoto/Patrick Heagney. Model used for illustrative purposes only.