# Acute Pericarditis - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64) - Verified date: 2026-08 ## Verified against - 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64) - Acute Pericarditis - disease-level clinical article (acute-pericarditis-clinical.txt) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Acetylsalicylic acid — oral.solid - Referral & safety-netting (no drug therapy) - Colchicine — 0.5 mg — oral.solid ## Complete treatment card ```text ACUTE PERICARDITIS Sources: 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64) Review status: REVIEWED against 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64), Acute Pericarditis - disease-level clinical article (acute-pericarditis-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Chest pain is central and severe, worse with a deep breath, and eases when sitting forward [chest pain] - Pain can radiate to the trapezius ridges when the phrenic nerve is irritated - Breathlessness may dominate the picture when myocarditis is present alongside it [breathlessness] - A flu-like illness with fever or upper respiratory symptoms often comes before a viral cause [fever] - Symptoms can appear days to weeks after prior cardiac surgery or chest trauma - Recurrence runs at an estimated 15% to 30% of cases [relapse] - The pericardium can thicken and, rarely, go on to constrict the heart months or even years after the attack SIGNS - what you find (10) - A left parasternal friction rub with a scratchy triphasic quality is heard on auscultation [friction rub] - The friction rub is heard at some point in roughly 35% to 85% of cases, with wide variation reported [friction rub] - A triphasic friction rub, when heard, is highly specific for the diagnosis [friction rub] - A missing friction rub does not exclude pericarditis when the clinical picture still points that way [friction rub] - A friction rub can come and go, so listening repeatedly in different positions is needed [friction rub] - In uremic pericarditis, pleuritic pain is less common and ECG changes are often absent [chest pain] - Red flag: an effusion that is large or forms fast compresses the chambers from outside, restricts diastolic filling, and tips into cardiac tamponade - Red flag: tamponade presents as obstructive shock, and it is an emergency needing treatment at once [shock] - Meeting the criteria with raised cardiac biomarkers makes it myopericarditis; add a wall motion abnormality or systolic dysfunction and it is perimyocarditis - Red flag: an ejection fraction under 50%, heart failure, shock, sustained ventricular tachycardia or advanced heart block make it complicated myocarditis [heart block · shock · tachycardia] TESTS (12) - All suspected cases should get an ECG, echocardiogram, chest x-ray, and troponin and inflammatory markers - Stage I ECG changes show widespread concave ST elevation with reciprocal depression in lead aVR - PR-segment elevation in lead aVR helps tell pericarditis apart from a heart attack on ECG - Widespread T-wave inversion marks stage III of the ECG evolution - Meeting 2 or more of the listed criteria makes the diagnosis definitive rather than probable - A pericardial effusion drops mitral inflow velocity by 30% on inspiration on echo - Cardiac MRI is recommended when the diagnosis is unclear or myocarditis is suspected - Emergency pericardiocentesis is needed for cardiac tamponade - A pericardial fluid glucose-to-serum ratio under 0.3 with neutrophil predominance points away from TB or malignancy - Confirmed TB pericarditis is treated for at least 6 months - Pericardiectomy is considered if symptoms have not improved after 4 to 8 weeks of TB therapy - The fluid names the cause: thick and cloudy is usually bacterial, caseous strongly suggests tuberculosis, and blood-stained points to malignancy, tuberculosis, or recent cardiac surgery IF NOT THIS - what else fits (7) - Stable angina or an acute coronary syndrome can present with similar chest pain - Subendocardial ischemia from aortic stenosis or hypertrophic cardiomyopathy is a differential - Aortic dissection is an important differential to exclude - Pulmonary embolism causing pleurisy is on the differential list - Costochondritis, oesophageal spasm, and peptic ulcer disease are also differentials - Referred pain from another organ, such as acute cholecystitis, should be considered - Bone-related pain and angina are also listed among the differentials for this chest pain Source StatPearls "Pericarditis" - disease-level clinical article Status traced to the source above 1. IBUPROFEN [1st line] Adult 600 mg orally every 8 hours (1800 mg/day) for 1 to 2 weeks, guided by symptoms and CRP, then tapered (decrease dose by 200-400 mg every 1-2 weeks). x 1 to 2 weeks, then tapered Peds The guideline is written for adults. Pericarditis in a child is a paediatric cardiology problem, not a primary-care dosing decision. Choice Alternatives. The cited guideline names aspirin and NSAIDs together as the mainstay; ibuprofen is the cheaper and the one most reached for outside a post-infarct patient. Source 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64) Why The guideline names aspirin or an NSAID as the mainstay of therapy for acute pericarditis, and gives ibuprofen at 1200-2400 mg/day with treatment duration guided by symptoms and CRP. Caution Confirm the diagnosis before treating: pleuritic chest pain relieved by sitting forward, a friction rub, widespread ST elevation or PR depression on ECG, or a pericardial effusion. Chest pain is not pericarditis until the alternatives are excluded. GASTROPROTECTION is part of the recommendation, not optional - the guideline states it should be provided with aspirin or an NSAID at these doses. Taper rather than stop abruptly; the guideline recommends tapering be considered. Rest matters and is the guideline's first non-drug recommendation: restrict activity beyond ordinary sedentary life until symptoms resolve and CRP normalises. Refer the same day if there is fever above 38C, a large effusion, tamponade, trauma, immunosuppression, anticoagulation, or a failure to respond after a week - these mark a poor prognosis. Rising troponin means myopericarditis, which is a different problem and needs cardiology. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 2. ACETYLSALICYLIC ACID [1st line] Adult 750-1000 mg every 8 hours for 1 to 2 weeks, then tapered. Preferred over an NSAID when the patient already needs aspirin, for example after a myocardial infarction x 1 to 2 weeks, symptom and CRP guided Peds NOT for children. Aspirin in a child carries the risk of Reye's syndrome, and paediatric pericarditis is a cardiology problem in any case. Source 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64) Why The guideline names aspirin alongside NSAIDs as the mainstay of therapy. It is the anti- inflammatory of choice where antiplatelet treatment is wanted anyway, since an NSAID would otherwise be added on top of it. Caution Sold in Egypt as acetylsalicylic acid - aspirin is the common name, not the register name. This is anti-inflammatory dosing, several times the antiplatelet dose - do not confuse it with 75-150 mg once daily. GASTROPROTECTION is part of the recommendation at this dose. Confirm the diagnosis before treating: pleuritic chest pain relieved by sitting forward, a friction rub, widespread ST elevation or PR depression on ECG, or a pericardial effusion. Chest pain is not pericarditis until the alternatives are excluded. Taper rather than stop abruptly. Acetylsalicylic acid is not for children - there is a risk of Reye's syndrome. Egypt ASPOCID 300 MG 200 TABS. CID 80.00 EGP (0.40/unit) AGGREX 75MG 60 TABS. RAMEDA 33.00 EGP (0.55/unit) ASPOCID 75MG 20 TAB. CID 22.00 EGP (1.10/unit) ECOPRIN 325MG 10 ENTERIC COATED TAB. SIGMA 5.00 EGP RIVO 75 MG 30 CHEW. TABS. ARAB DRUG COM... 21.00 EGP ASPRICARLO 81MG 30 CHEWABLE TABS. EUROPEAN EGYPTIAN PHARM. IND. 45.00 EGP ASPIRIN PROTECT 100 MG 30 GASTRO-RESISTANT TABS. MEMPHIS > BAYER BITTERF... 78.00 EGP JUSPRIN 81 MG 60 E.C.TABS. FUTURE PHARMA... 81.00 EGP 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Pericarditis - disease-level clinical article (acute-pericarditis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The admission criteria for poor prognostic markers are fever >38°C, subacute/recurrent presentation, large effusion, cardiac tamponade, or failure to respond within 1 week. 4. COLCHICINE [add-on - not a substitute] Adult 0.5 mg ONCE daily if under 70 kg, or 0.5 mg TWICE daily if 70 kg or over, for 3 months. After a recurrence the guideline's trials used 6 months x 3 months (6 months after a recurrence) Peds The guideline is written for adults and does not dose children for this indication. Source 2015 ESC Guidelines for the diagnosis and management of pericardial diseases, European Society of Cardiology (Eur Heart J 2015;36:2921-64) Why The guideline recommends colchicine as first-line therapy in addition to aspirin or an NSAID, at low weight-adjusted doses. It is what reduces recurrence, which is the main problem in this condition - so it is an add-on to the anti-inflammatory, never a replacement for it. Caution GIVE IT WITH THE ANTI-INFLAMMATORY, NOT INSTEAD OF IT. It is what cuts the recurrence rate, and recurrence is the main problem in pericarditis. The dose is weight-split at 70 kg: 0.5 mg once daily under 70 kg, 0.5 mg twice daily at 70 kg and over. It is NOT the gout regimen. Egypt's commonest colchicine tablet is 1 mg, so the 0.5 mg dose usually means half a tablet; 500 microgram and 0.6 mg tablets are also registered. The colchicine product label does not carry pericarditis - it covers gout and familial Mediterranean fever. This dose is from the ESC guideline, not the licence. Reduce or avoid in significant renal or hepatic impairment, and it interacts dangerously with clarithromycin and with statins. Colchicine 500 microgram tablets SmPC (https://www.medicines.org.uk/emc/product/100968), s4.5: "Colchicine is contraindicated in patients with renal or hepatic impairment who are taking a P-gp inhibitor ... or a strong CYP3A4 inhibitor (e.g. ritonavir, atazanavir, indinavir, clarithromycin, telithromycin, itraconazole or ketoconazole)"; and "The risk of myopathy and rhabdomyolysis is increased by a combination of colchicine with statins, fibrates, ciclosporin or digoxin." Diarrhoea is the usual reason it is stopped; it is dose-related. Confirm the diagnosis before treating: pleuritic chest pain relieved by sitting forward, a friction rub, widespread ST elevation or PR depression on ECG, or a pericardial effusion. Chest pain is not pericarditis until the alternatives are excluded. Egypt COLCHICINE 500 MCG 100 TABS. EL NASR 190.00 EGP (1.90/unit) COLMEDITEN 0.5 MG 100 TABS. KAHIRA 190.00 EGP (1.90/unit) GOURYST 0.5 MG 100 TABS. PHAROPHARMA 190.00 EGP (1.90/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)