Pericarditis differential diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [3] Homa Najafi, M.D.[4]
Overview
Overview
Pericarditis must be differentiated from diseases presenting with chest pain, shortness of breath and tachypnea which include myocardial infarction, pulmonary embolism, congestive heart failure, pneumonia, vasculitis, and chronic obstructive pulmonary disease (COPD). Manifestation of the pericarditis can help in differentiation from myocardial infarction. Moreover, other differential diagnosis include aortic stenosis, coronary artery vasospasm, esophageal rupture, esophageal spasm, esophagitis,acute gastritis, gastroesophageal reflux disease, and peptic ulcer disease should be considered.
Differentiating Pericarditis from other Diseases
Differentiating Pericarditis from other Diseases
- Pericarditis must be differentiated from diseases presenting with chest pain, shortness of breath and tachypnea.
- For a full discussion of the differential diagnosis of chest pain click here
- For an expert algorithm that aids in the diagnosis of the cause of chest pain click here
- Pericarditis must be differentiated from myocardial infarction as an important cause of chest pain.The differentiating features include:[1]
| Characteristic/Parameter | Pericarditis | Myocardial infarction |
|---|---|---|
| Pain description | Sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain. | Crushing, pressure-like, heavy pain. Described as “elephant on the chest“. |
| Radiation | Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation. | Pain radiates to the jaw, or the left or arm, or does not radiate. |
| Exertion | Does not change the pain | Can increase the pain |
| Position | Pain is worse supine or upon inspiration (breathing in) | Not positional |
| Onset/duration | Sudden pain, that lasts for hours or sometimes days before a patient comes to the ER | Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the patient decides to come to the ER |
Differentiating pericarditis from other diseases on the basis of chest pain, shortness of breath, and tachypnea
The differentials include the following:[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]
| Diseases | Diagnostic tests | Physical Examination | Symptoms | Past medical history | Other Findings | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CT scan and MRI | EKG | Chest X-ray | Tachypnea | Tachycardia | Fever | Chest Pain | Hemoptysis | Dyspnea on Exertion | Wheezing | Chest Tenderness | Nasalopharyngeal Ulceration | Carotid Bruit | |||
| Pulmonary embolism |
|
|
|
β | β | β (Low grade) | β | β (In case of massive PE) | β | – | – | – | – |
|
|
| Congestive heart failure |
|
β | β | β | – | – | β | – | – | – | – |
|
| ||
| Percarditis |
|
|
|
β | β | β (Low grade) | β (Relieved by sitting up and leaning forward) | – | β | – | – | – | – |
|
|
| Pneumonia |
|
|
|
β | β | β | β | – | β | β | – | – | – |
|
|
| Vasculitis |
|
|
β | β | β | β | β | β | – | β | β | β |
|
||
| Chronic obstructive pulmonary disease (COPD) |
|
|
β | β | – | – | – | β | β | – | – | – |
|
| |
Other differentials
Pericarditis also resembles the following disorders and needs to be differentiated from them:
- Angina pectoris
- Aortic stenosis
- Coronary artery vasospasm
- Esophageal rupture
- Esophageal spasm
- Esophagitis
- Gastritis, acute
- Gastroesophageal reflux disease
- Peptic ulcer disease
References
- β American College of Physicians (ACP). Medical Knowledge Self-Assessment Program (MKSAP-15): Cardiovascular Medicine. “Pericardial disease.” p. 64. ISBN 978-934465-28-8 [1]
- β Brenes-Salazar JA (2014). “Westermark’s and Palla’s signs in acute and chronic pulmonary embolism: Still valid in the current computed tomography era”. J Emerg Trauma Shock. 7 (1): 57β8. doi:10.4103/0974-2700.125645. PMCΒ 3912657. PMIDΒ 24550636.
- β “CT Angiography of Pulmonary Embolism: Diagnostic Criteria and Causes of Misdiagnosis | RadioGraphics”.
- β BΔlohlΓ‘vek J, Dytrych V, Linhart A (2013). “Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism”. Exp Clin Cardiol. 18 (2): 129β38. PMCΒ 3718593. PMIDΒ 23940438.
- β “Pulmonary Embolism: Symptoms – National Library of Medicine – PubMed Health”.
- β Ramani GV, Uber PA, Mehra MR (2010). “Chronic heart failure: contemporary diagnosis and management”. Mayo Clin. Proc. 85 (2): 180β95. doi:10.4065/mcp.2009.0494. PMCΒ 2813829. PMIDΒ 20118395.
- β Blinderman CD, Homel P, Billings JA, Portenoy RK, Tennstedt SL (2008). “Symptom distress and quality of life in patients with advanced congestive heart failure”. J Pain Symptom Manage. 35 (6): 594β603. doi:10.1016/j.jpainsymman.2007.06.007. PMCΒ 2662445. PMIDΒ 18215495.
- β Hawkins NM, Petrie MC, Jhund PS, Chalmers GW, Dunn FG, McMurray JJ (2009). “Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology”. Eur. J. Heart Fail. 11 (2): 130β9. doi:10.1093/eurjhf/hfn013. PMCΒ 2639415. PMIDΒ 19168510.
- β Takasugi JE, Godwin JD (1998). “Radiology of chronic obstructive pulmonary disease”. Radiol. Clin. North Am. 36 (1): 29β55. PMIDΒ 9465867.
- β Wedzicha JA, Donaldson GC (2003). “Exacerbations of chronic obstructive pulmonary disease”. Respir Care. 48 (12): 1204β13, discussion 1213β5. PMIDΒ 14651761.
- β Nakawah MO, Hawkins C, Barbandi F (2013). “Asthma, chronic obstructive pulmonary disease (COPD), and the overlap syndrome”. J Am Board Fam Med. 26 (4): 470β7. doi:10.3122/jabfm.2013.04.120256. PMIDΒ 23833163.
- β Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, Oh JK (2010). “Pericardial disease: diagnosis and management”. Mayo Clin. Proc. 85 (6): 572β93. doi:10.4065/mcp.2010.0046. PMCΒ 2878263. PMIDΒ 20511488.
- β Bogaert J, Francone M (2013). “Pericardial disease: value of CT and MR imaging”. Radiology. 267 (2): 340β56. doi:10.1148/radiol.13121059. PMIDΒ 23610095.
- β Gharib AM, Stern EJ (2001). “Radiology of pneumonia”. Med. Clin. North Am. 85 (6): 1461β91, x. PMIDΒ 11680112.
- β Schmidt WA (2013). “Imaging in vasculitis”. Best Pract Res Clin Rheumatol. 27 (1): 107β18. doi:10.1016/j.berh.2013.01.001. PMIDΒ 23507061.
- β Suresh E (2006). “Diagnostic approach to patients with suspected vasculitis”. Postgrad Med J. 82 (970): 483β8. doi:10.1136/pgmj.2005.042648. PMCΒ 2585712. PMIDΒ 16891436.
- β Stein PD, Dalen JE, McIntyre KM, Sasahara AA, Wenger NK, Willis PW (1975). “The electrocardiogram in acute pulmonary embolism”. Prog Cardiovasc Dis. 17 (4): 247β57. PMIDΒ 123074.
- β Warnier MJ, Rutten FH, Numans ME, Kors JA, Tan HL, de Boer A, Hoes AW, De Bruin ML (2013). “Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease”. COPD. 10 (1): 62β71. doi:10.3109/15412555.2012.727918. PMIDΒ 23413894.
- β Stein PD, Matta F, Ekkah M, Saleh T, Janjua M, Patel YR, Khadra H (2012). “Electrocardiogram in pneumonia”. Am. J. Cardiol. 110 (12): 1836β40. doi:10.1016/j.amjcard.2012.08.019. PMIDΒ 23000104.
- β Hazebroek MR, Kemna MJ, Schalla S, Sanders-van Wijk S, Gerretsen SC, Dennert R, Merken J, Kuznetsova T, Staessen JA, Brunner-La Rocca HP, van Paassen P, Cohen Tervaert JW, Heymans S (2015). “Prevalence and prognostic relevance of cardiac involvement in ANCA-associated vasculitis: eosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis”. Int. J. Cardiol. 199: 170β9. doi:10.1016/j.ijcard.2015.06.087. PMIDΒ 26209947.
- β Dennert RM, van Paassen P, Schalla S, Kuznetsova T, Alzand BS, Staessen JA, Velthuis S, Crijns HJ, Tervaert JW, Heymans S (2010). “Cardiac involvement in Churg-Strauss syndrome”. Arthritis Rheum. 62 (2): 627β34. doi:10.1002/art.27263. PMIDΒ 20112390.
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