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Diagnostic criteria for acute pericarditis and myopericarditis in the clinical setting

Diagnostic criteria for acute pericarditis and myopericarditis in the clinical setting
Acute pericarditis (at least 2 criteria of 4 should be present)*:
  1. Typical chest pain
  1. Pericardial friction rub
  1. Suggestive ECG changes (typically widespread ST-segment elevation)
  1. New or worsening pericardial effusion
Myopericarditis or perimyocarditis:
  1. Definite diagnosis of acute pericarditis, plus
  1. Suggestive symptoms (dyspnea, palpitations, or chest pain) and ECG abnormalities beyond normal variants, not documented previously (ST/T abnormalities, supraventricular or ventricular tachycardia or frequent ectopy, atrioventricular block), or focal or diffuse depressed LV function of uncertain age by an imaging study
  1. Absence of evidence of any other cause
  1. One of the following features: Evidence of elevated cardiac enzymes (creatine kinase-MB fraction, or troponin I or T), or new onset of focal or diffuse depressed LV function by an imaging study, or abnormal imaging consistent with myocarditis (MRI with gadolinium, gallium-67 scanning, anti-myosin antibody scanning)
Case definitions for myopericarditis or perimyocarditis include:
Suspected myopericarditis or perimyocarditis: Criteria 1 plus 2 and 3
Probable myopericarditis or perimyocarditis: Criteria 1, 2, 3, and 4
Confirmed myopericarditis or perimyocarditis: Histopathologic evidence of myocarditis by endomyocardial biopsy or on autopsyΔ

ECG: electrocardiogram; LV: left ventricular; MRI: magnetic resonance imaging.

* Pericardial effusion confirms the clinical diagnosis, but its absence does not exclude it.

¶ The term "myopericarditis" refers to cases of confirmed acute pericarditis with elevated troponin but without LV systolic dysfunction. The term "perimyocarditis" refers to cases presenting as acute pericarditis with elevated troponin and LV ejection fraction less than 55%. The diagnostic approach and management for perimyocarditis are the same as for myocarditis.

Δ While a confirmed diagnosis would require an endomyocardial biopsy, in clinical practice this is not warranted for self-limited cases with predominant pericarditis.
Original table modified for this publication. Reproduced with permission from: Imazio M, Trinchero R. Triage and management of acute pericarditis. Int J Cardiol 2007; 118:286. Copyright © 2007 Elsevier.
Graphic 74376 Version 8.0

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