Pericarditis Diagnostic Tests and Procedures

Pericarditis is a condition characterized by inflammation of the pericardium, the sac-like membrane surrounding the heart. Common symptoms include chest pain, shortness of breath, palpitations, and discomfort that may worsen when lying down. Accurate diagnosis is crucial to determine the underlying cause and guide appropriate treatment. Below are the key diagnostic tests used in evaluating pericarditis:

Imaging and Cardiac Monitoring

Electrocardiogram (ECG): A 12-lead ECG is often the first test performed. It can detect specific changes such as diffuse ST-segment elevation, which are typical in acute pericarditis.

Echocardiogram: This ultrasound of the heart helps visualize the pericardium and can detect pericardial effusion — a buildup of excess fluid around the heart. It also assesses heart function and rules out other conditions like cardiac tamponade.

Chest Computed Tomography (CT) Scan: A CT scan provides detailed images of the heart and surrounding structures. It is particularly useful in identifying pericardial thickening, effusion, or signs of infection or malignancy.

Magnetic Resonance Imaging (MRI): Cardiac MRI offers high-resolution images of the pericardium and can help differentiate between acute and chronic inflammation, as well as detect signs of constriction or fibrosis.

Identifying Specific Causes

Tuberculous Pericarditis: If tuberculosis is suspected, a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) may be performed. Additionally, T-cell assays specific for Mycobacterium tuberculosis can support the diagnosis.

Purulent Pericarditis: In suspected bacterial cases, pericardiocentesis — the removal of fluid from the pericardial space — may be performed. The fluid is analyzed for color, consistency, and presence of bacteria, white blood cells, or other markers of infection.

Other Inflammatory and Autoimmune Causes

Rheumatic Pericarditis: Blood tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) help assess the level of inflammation. Anti-streptolysin O (ASO) titers may be ordered to confirm a recent streptococcal infection, which can trigger rheumatic fever and associated pericardial involvement.

Heart Failure-Related Effusion

In cases where pericardial effusion is linked to heart failure, especially in advanced cases, echocardiography plays a vital role in assessing ventricular function and overall cardiac performance.

Each of these diagnostic tools helps clinicians determine the type and severity of pericarditis, enabling a tailored treatment approach. If you experience persistent chest discomfort or other symptoms, it is important to seek medical evaluation promptly.