Acute Pericarditis vs Myocarditis
Acute Pericarditis and Myocarditis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Acute Pericarditis vs Myocarditis at a glance
- Acute Pericarditis: Inflammation of the pericardium — pleuritic chest pain improved by leaning forward, friction rub, diffuse ST elevation with PR depression.
- Myocarditis: Inflammation of the myocardium, most often viral, presenting as new-onset HF, chest pain, or arrhythmia in a previously healthy patient.
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Side-by-side comparison
| Feature | Acute Pericarditis | Myocarditis |
|---|---|---|
| At a glance | Inflammation of the pericardium — pleuritic chest pain improved by leaning forward, friction rub, diffuse ST elevation with PR depression. | Inflammation of the myocardium, most often viral, presenting as new-onset HF, chest pain, or arrhythmia in a previously healthy patient. |
| Classic presentation | Sharp, pleuritic, retrosternal or left precordial chest pain; Worse supine, better leaning forward; Radiation to trapezius ridge (highly specific — phrenic… | Young, previously healthy patient with new HF or chest pain after a recent flu-like illness, troponin elevation, and unobstructed coronaries on angiography.;… |
| Workup / key labs | Acute pericarditis ≥2 of 4: (1) sharp pleuritic pain improved leaning forward, (2) pericardial friction rub, (3) new widespread ST elevation or PR depression,… | Troponin I or T (elevated, may be persistently elevated); BNP/NT-proBNP; CRP, ESR (often elevated); CBC with differential (eosinophilia suggests eosinophilic… |
| Imaging | 12-lead ECG — diffuse concave ST elevation with PR segment depression (PR elevation in aVR is reciprocal — early sign); Echocardiography — assess for… | 12-lead ECG: sinus tachycardia, nonspecific ST/T changes, low voltage, conduction blocks, ventricular ectopy or VT; CXR: may show cardiomegaly and pulmonary… |
| First-line treatment | NSAIDs — ibuprofen 600-800 mg PO TID × 1-2 weeks then taper, OR aspirin 750-1000 mg PO TID (preferred post-MI pericarditis); Colchicine 0.5 mg PO BID (0.5 mg… | Supportive care: hospitalization for telemetry monitoring; restrict competitive exercise for 3-6 months; Guideline-directed medical therapy for HFrEF:… |
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