Current shifting trends in the diagnosis, management and recurrence of acute pericarditis: A cross-sectional study

Introduction: Acute pericarditis is an inflammatory disease of the pericardium that may be caused by several etiologies, usually benign. The electrocardiograph (ECG) is considered important in the diagnosis, though relevant electrocardiographic findings were described decades ago, with the epidemiology of pericarditis having changed since.

Materials and methods: We reviewed 401 cases of acute pericarditis (Mean age 59, 65% male) in Sheba Medical Center in Tel-Ha’Shomer during 2008-2016, and examined correlations between ECG findings and major clinical, laboratory and echocardiographic findings.

Results and discussion: Pericarditis was idiopathic in 233 cases (58%), postpericardiotomy (PPS) in 131 (33%), and 37 were due to other causes. In 35% of cases, any ECG sign was recognized. ST-elevations and PR-depressions were documented in 23% and 17% of cases, respectively. Other signs were seen in 12-22% of cases. ST-elevations (31% vs 9%, p<0.001) and PR depressions (24% vs 7%, p=0.005) and other ECG signs were more common in idiopathic pericarditis than in PPS. All signs were negatively associated with the presence and severity of a pericardial effusion, which was present in 67% of cases.

Conclusions: Electrocardiographic signs of pericarditis were seen in a minority of cases, and were associated with an idiopathic etiology and the absence of a pericardial effusion. These findings may reflect changes in the clinical practices surrounding the diagnosis of acute pericarditis, in the age of highly available echocardiography, and specifically bedside echocardiography and point-of-care ultrasound.