Pericarditis vs Myocarditis
How to tell Pericarditis and Myocarditis apart when a board question makes them look alike.
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New left ventricular systolic dysfunction on echocardiography points to myocarditis.
Side by side
Sharp pleuritic chest pain improved by sitting forward with diffuse ST elevation and PR depression supports pericarditis.
Recent viral prodrome with chest pain plus new heart-failure signs, troponin rise, and ventricular dysfunction supports myocarditis.
Inflammation of pericardial layers causes friction pain and diffuse epicardial ECG changes.
Inflammatory myocyte injury impairs contractility and may trigger arrhythmia or cardiogenic shock.
ECG shows diffuse concave ST elevation with PR depression, troponin may be mildly elevated, and echo may show small effusion without global systolic failure.
Myocarditis often has elevated troponin and BNP with echocardiographic reduction in left ventricular ejection fraction and regional or global hypokinesis.
The trap
Patients with myocarditis are treated as simple pericarditis and discharged on NSAIDs despite reduced ejection fraction or arrhythmias. Ventricular dysfunction should trigger admission and heart-failure-directed monitoring.
The repair move
Next best step: admit for telemetry and hemodynamic monitoring, obtain echocardiography promptly, treat heart failure with guideline-directed supportive care as tolerated, and avoid strenuous activity for at least 3 to 6 months in myocarditis. Uncomplicated pericarditis with preserved ventricular function is treated with NSAID plus colchicine.
Try a free question
CoreA 25-year-old with recent viral illness has chest pain, troponin elevation, and echocardiogram showing ejection fraction 30 percent. What is the next best step in management?
Show answer and explanation
Answer: A. Hospitalize for myocarditis monitoring and heart-failure-directed care. Myocarditis with ventricular dysfunction requires inpatient monitoring and supportive cardiology management.
Why the other choices are tempting
- B. Wrong. NSAID-only outpatient treatment is unsafe with reduced ejection fraction.
- C. Wrong. Ongoing myocardial injury requires follow-up and monitoring.
- D. Wrong. Thrombolysis is not indicated.
- E. Wrong. Universal anticoagulation is not routine without specific indication.
Flashcards
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Which imaging finding most quickly separates myocarditis from isolated pericarditis?
Reduced left ventricular ejection fraction or global hypokinesis on echocardiography.
What positional chest pain pattern favors pericarditis?
Pain worsens supine and improves when leaning forward.
Quick answers
What is the fastest way to tell Pericarditis from Myocarditis?
New left ventricular systolic dysfunction on echocardiography points to myocarditis.
What is the key clue for Pericarditis?
Sharp pleuritic chest pain improved by sitting forward with diffuse ST elevation and PR depression supports pericarditis.
What is the key clue for Myocarditis?
Recent viral prodrome with chest pain plus new heart-failure signs, troponin rise, and ventricular dysfunction supports myocarditis.
What is the common trap with Pericarditis vs Myocarditis?
Patients with myocarditis are treated as simple pericarditis and discharged on NSAIDs despite reduced ejection fraction or arrhythmias. Ventricular dysfunction should trigger admission and heart-failure-directed monitoring.