2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis: A Report of the American College of Cardiology Solution Set Oversight Committee

Abstract

Section snippets

Solution Set Oversight Committee

Gurusher S. Panjrath, MBBS, FACC, ChairNicole M. Bhave, MD, FACC, Immediate Past Chair^∗Niti R. Aggarwal, MD, FACC^∗Katie Bates, ARNP, DNPEugene Chung, MD, MPH, FACCDavid M. Dudzinski, MD, JD, FACCJohn P. Erwin III, MD, FACC^∗Martha Gulati, MD, MS, FACCRobert Hendel, MD, MACCDharam J. Kumbhani, MD, SM, FACC^∗Chayakrit Krittanawong, MD, FACCBarbara Wiggins, PharmD, FACCMegan Coylewright, MD, MPH, FACC—Ex Officio

Table of Contents

• Preface 2
• 1.Introduction 3
• 2.Assumptions and Definitions 3
  • 2.1.General Clinical Assumptions 3
  • 2.2.Definitions 3
  • 2.3.Abbreviations 3
• 3.Summary Graphic 4
  • Figure 1. Novel Clinical and Advanced Multimodality Imaging Evaluation Guiding Therapeutics for Pericarditis 4
• 4.Description, Rationale, and Implications 4
  • 4.1.General Perspectives for Pericardial Diseases 4
    • 4.1.1.Anatomy and Physiology 4
      • Figure 2. Anatomy of the Pericardium 5
    • 4.1.2.Epidemiology and Etiologies 6
    • 4.1.3.The Role of Inflammation in Pericardial Disease 6
      • Figure 3. Pathophysiology of Pericardial

Preface

The American College of Cardiology (ACC) has a long history of developing documents (eg, decision pathways, appropriate use criteria) to provide clinicians with guidance on both clinical and nonclinical topics relevant to cardiovascular care. In most circumstances, these documents have been created to complement clinical practice guidelines and to inform clinicians about areas where evidence is new and evolving or where sufficient data is more limited. Despite this, numerous gaps persist,

General Clinical Assumptions

• 1.This CCG presumes the physician will collaborate with appropriate specialists, such as a cardiologist, pharmacist, and/or other relevant specialists (eg, rheumatologist, cardiac surgeon, radiologist), and/or pericardial center of excellence program members, including advanced practice providers, to guide clinical management.
• 2.In all cases, clinical management should be guided by evidence-based clinical judgment, with shared decision-making that incorporates patient preferences and values.
• 3.This CCG

Summary Graphic

Anatomy and Physiology

The pericardial anatomy, through the interplay of its fibrous parietal layer and elastic visceral layer, have pivotal roles in modulating cardiac pressure-volume dynamics, ensuring optimal chamber restraint and preventing overexpansion during cardiac cycles.1, 2, 3 The parietal pericardium is an outer fibrous sac lined by a single layer of mesothelial cells, which envelops the proximal great arteries, pulmonary veins, and venae cavae to form pericardial sinuses and recesses. The visceral

Conclusions

Pericarditis remains a challenging and heterogenous condition not infrequently encountered in clinical practice. A novel diagnostic criteria for pericarditis has been devised, consisting of pericarditic chest pain with 5 additional criteria (0 = unlikely pericarditis, 1 = possible pericarditis, 2+ = definite diagnosis). These criteria include clinical findings of pericardial rub, ECG changes, new or worsening pericardial effusions, serologic findings of elevated inflammatory markers, and

President and Staff

American College of CardiologyChristopher M. Kramer, MD, FACCCathleen C. Gates, Chief Executive OfficerRichard J. Kovacs, MD, MACC, Chief Medical OfficerBrendan Mullen, Senior Executive Vice PresidentJoseph M. Allen, MA, Team Leader, Science & QualityAmy Dearborn, Team Leader, Decision ScienceAshleigh M. Covington, MA, Team Leader, Decision Science DeliveryAlan Shinkar, MPH, Project Manager, Decision Science DeliveryGrace D. Ronan, Senior Production and Operations Manager, Clinical Policy