New ACC 2025 Guidance on Pericarditis Source: Journal of the American College of Cardiology, 6 August 2025.
New ACC 2025 Guidance on Pericarditis
Source: Journal of the American College of Cardiology, 6 August 2025.
1. Condition Overview:
• Pericarditis = inflammation of the pericardium; ~5% of ED chest pain cases.
• Most common in men aged 16–65; recurrent cases more frequent in women.
• Causes vary: idiopathic/viral (high-income countries), tuberculosis (low-income), infection, autoimmune disease, post-cardiac injury, others.
2. Diagnosis & First-Line Imaging:
• Transthoracic echocardiography (TTE) is the primary, first-line imaging tool in all suspected cases.
• In most uncomplicated cases, TTE alone is sufficient for diagnosis and follow-up.
3. When Additional Imaging is Needed:
• Cardiac MR (CMR): when diagnosis is unclear on echo, for tissue characterization, inflammation detection, or recurrent cases.
• Cardiac CT (CCT): for suspected pericardial calcification, constrictive pericarditis, pre-surgical planning, or ruling out other causes of chest pain (e.g., aortic syndrome, PE, CAD).
• Additional imaging is not routine—it is reserved for specific clinical indications.
4. Classification:
• Pericarditis is classified by etiology, clinical course, morphology, and pericardial fluid characteristics (type, size, hemodynamic effect).
5. Treatment Principles:
• First-line: NSAIDs and colchicine with physical activity restriction. Acute pericarditis is treated with an NSAID plus colchicine from day 1.
Ibuprofen (Brufen): 600–800 mg orally every 8 h until symptoms and CRP normalize, then taper over 1–2 weeks; give a PPI for gastric protection. Avoid in severe renal impairment.
Colchicine: ≥70 kg: 0.5–0.6 mg twice daily; <70 kg, age >70, or moderate renal impairment: once daily. Duration: 3 months (6–12 months if recurrent). Avoid in severe kidney/liver disease
• If inadequate response: consider IL-1 inhibitors (e.g., rilonacept, anakinra) or corticosteroids when indicated.
• Pericardiectomy for resistant or constrictive cases.
6. Centers of Excellence (Pericardial Disease Centers – PDCs):
• Provide multidisciplinary expertise for recurrent/refractory pericarditis.
• Improve outcomes through standardized protocols, access to clinical trials, and monitoring of new therapies and adverse events.
