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 nerve); Low-grade fever, dyspnea, fatigue; Antecedent viral prodrome (URI, GI symptoms) common; Pericardial friction rub — three-component, scratchy, best at LLSB with patient… | Young, previously healthy patient with new HF or chest pain after a recent flu-like illness, troponin elevation, and unobstructed coronaries on angiography.; Recent viral prodrome (URI, gastroenteritis) days to weeks prior; Chest pain (can mimic MI), dyspnea, palpitations; Acute decompensated heart failure: orthopnea, fatigue,… |
| 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, (4) new/worsening pericardial effusion. Supporting features: elevated CRP, evidence of inflammation on imaging.; Troponin — modest elevation suggests myopericarditis; high values… | Troponin I or T (elevated, may be persistently elevated); BNP/NT-proBNP; CRP, ESR (often elevated); CBC with differential (eosinophilia suggests eosinophilic myocarditis or hypersensitivity); Viral PCR panel (limited yield; not routinely required for diagnosis); Targeted testing if suspected: Lyme serologies, HIV, ANA, rheumatoid… |
| Imaging | 12-lead ECG — diffuse concave ST elevation with PR segment depression (PR elevation in aVR is reciprocal — early sign); Echocardiography — assess for pericardial effusion and ventricular function (rule out tamponade and myocarditis); CXR — typically normal; cardiomegaly only with large effusion; Cardiac MRI — late gadolinium enhancement… | 12-lead ECG: sinus tachycardia, nonspecific ST/T changes, low voltage, conduction blocks, ventricular ectopy or VT; CXR: may show cardiomegaly and pulmonary edema; Transthoracic echo: global or regional LV dysfunction, wall thickening from edema, pericardial effusion; Cardiac MRI: late gadolinium enhancement (typically subepicardial,… |
| 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 daily if <70 kg) × 3 months — added to NSAID for FIRST episode reduces recurrence (COPE / ICAP trials); Proton pump inhibitor while on high-dose NSAIDs; Activity restriction until… | Supportive care: hospitalization for telemetry monitoring; restrict competitive exercise for 3-6 months; Guideline-directed medical therapy for HFrEF: ACEi/ARB or sacubitril/valsartan, evidence-based beta-blocker (carvedilol, metoprolol succinate, bisoprolol), MRA (spironolactone, eplerenone), and SGLT2 inhibitor (dapagliflozin,… |
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