Risk Stratification

In order to appropriately risk stratify a patient with pericarditis, the emergency physician needs to consider the possible aetiology of the pericarditis along with the presence of high risk features. These high risk features (see Table below) are associated with a poorer prognosis and may help guide the need for inpatient management [5].

High Risk features:

  • Fever (>38°C or 100.4°F)
  • Subacute course
  • Large pericardial effusion (echo-free space >20 mm)
  • Cardiac tamponade (of note the classic triad of distended neck veins, muffled heart sounds and hypotension (Becks triad) may not be present. Echocardiography is required in all cases of suspected pericarditis in order to complete risk stratification)
  • Failure to respond to aspirin/non-steroidal anti-inflammatory drug (NSAID) therapy.
  • Myopericarditis (elevated troponin)
  • Immunsuppression
  • Trauma
  • Oral anticoagulant therapy

Learning bite

The presence of any high risk feature is associated with a poorer prognosis. These patients should be admitted for inpatient management [10,12].