Acute Pericarditis Differential Diagnosis: Understanding Similar Conditions

Acute pericarditis is a condition that must be carefully differentiated from several other serious medical issues that present with similar symptoms. Accurate diagnosis is crucial to ensure appropriate treatment and prevent complications.

1. Acute Myocardial Infarction (Heart Attack)

One of the primary conditions to distinguish acute pericarditis from is acute myocardial infarction. Chest pain associated with a heart attack typically occurs during physical activity and presents as a crushing or squeezing sensation in the center of the chest or upper sternum. Patients often describe a sense of impending doom or extreme anxiety, accompanied by profuse sweating and an inability to continue normal activities.

Upon hospital admission, electrocardiogram (ECG) changes characteristic of myocardial infarction become evident. Additionally, cardiac enzyme levels, such as troponin, show dynamic changes over time, which helps confirm the diagnosis.

2. Acute Pulmonary Embolism

Another critical condition to consider is acute pulmonary embolism. This type of chest pain usually starts suddenly and may occur in the precordial area. However, unlike pericarditis, it's often accompanied by signs of respiratory distress and hypoxia.

Symptoms may include cyanosis of the lips and nail beds, shortness of breath, and even hemoptysis (coughing up blood). In severe cases, patients may experience hypotension or go into shock. Pulmonary embolism is particularly common in individuals who have undergone recent pelvic or prostate surgery, orthopedic procedures, or gynecological operations, as well as those who are immobilized for extended periods.

3. Aortic Dissection

Aortic dissection represents one of the most dangerous conditions that must be differentiated from acute pericarditis. The pain associated with aortic dissection is often more intense than other forms of chest discomfort and is frequently described as a "tearing" or "ripping" sensation.

This pain can manifest in the anterior chest, abdomen, or even extend to the back, neck, or arms. Patients often report feeling as if their body is being split apart. The condition may also present with signs of poor perfusion and significant hypotension. Many patients with aortic dissection have a history of hypertension, making blood pressure control a key factor in prevention.

Proper differentiation between acute pericarditis and these potentially life-threatening conditions requires a comprehensive clinical evaluation, appropriate imaging studies, and laboratory testing to ensure timely and accurate diagnosis.