Table 1.

Diagnosis and proposed management of acute and recurrent pericarditis

		Acute pericarditis	Recurrent pericarditis
Work-up		History & Physical exam Electrocardiogram Transthoracic echocardiogram Cardiac biomarkers (troponin I or T) Chest radiograph or computed tomography (selected cases) Inflammatory biomarkers (erythrocyte sedimentation rate, C-reactive protein, anti-nuclear antibodies, complement factor 3 and 4) (selected cases) Cardiac magnetic resonance imaging (selected cases)
Diagnosis		2 of 4 of the followinga: Pericardial chest pain Pericardial rub New widespread ST elevation or PR depression on electrocardiogram Pericardial effusion (new or worsening)	All of the following: Documented first episode of acute pericarditis Symptom-free interval of 4–6 weeks or longer Diagnosis of pericarditis (same criteria as acute pericarditis)
Treatment	First line	NSAID (i.e. aspirin, diclofenac, ibuprofen) (if not contraindicated) AND Colchicine for 1–3 months	NSAID (i.e. aspirin, diclofenac, ibuprofen) (if not contraindicated) AND Colchicine for 3–6 months
	Second line	N/A	Anakinra Glucocorticoids (selected cases of autoimmune disorders)
	Refractoryb	N/A	Intravenous immunoglobulin (during the acute phase) OR Azathioprine (for long-term therapy) Pericardiectomy (last-line)

This algorithm represents the opinion of the authors based on the available literature as reviewed above. This algorithm has not been endorsed by any societal guidelines.

NSAID, non-steroidal anti-inflammatory drug.

^aAdditional supporting findings include: elevation of inflammation markers (i.e. C-reactive protein, erytrocyte sedimentation rate and white blood cell count) and evidence of pericardial inflammation by an imaging technique (computed tomography, magnetic resonance imaging).

^bDefined as proven infection-negative, corticosteroid-dependent, recurrent pericarditis not responsive to colchicine.