Pericarditis Management (ACC 2025)
Pericarditis Management (ACC 2025): Acute Pericarditis → First-Line: Dual Anti-inflammatory → Activity Restriction.
Interactive Decision Tree
Algorithm Steps
- ▶Start
Acute Pericarditis
≥2 of: pleuritic pain, friction rub, ECG changes, effusion
- ●Action
First-Line: Dual Anti-inflammatory
NSAID + Colchicine
- Aspirin 750-1g q8h OR Ibuprofen 600mg q8h
- PLUS Colchicine 0.5mg QD-BID
- Duration: 1-2 weeks NSAID, 3mo colchicine
- PPI for GI protection
- ●Action
Activity Restriction
Minimum 1 month
- Avoid strenuous exercise
- Athletes: 3 months
- ◆Decision
Response to First-Line?
If Yes:
- ✓Outcome
Resolved
Complete colchicine course
- ✓Outcome
Follow-Up
Echo, inflammatory markers, symptom monitoring
If No:
- ⚠Warning
Refractory/Recurrent
2025 Update: IL-1 inhibitors BEFORE steroids
- ●Action
IL-1 Inhibitors (Class I)
Preferred for inflammatory phenotype
- Rilonacept 320mg load → 160mg/wk SC
- OR Anakinra 100mg SC daily
- Duration: ≥12-18 months
- Evidence: RHAPSODY trial
- ⚠Warning
Pericardiectomy
Refractory or constrictive
- ●Action
Corticosteroids
Second-line (promotes chronicity)
- Low-dose prednisone
- Slow taper over months
- Avoid if possible
Guideline Source
2025 ACC Expert Consensus on Pericarditis
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address purulent/tuberculous pericarditis
- Immunosuppression protocols simplified
- Pericardiectomy criteria not detailed
Contraindicated Populations
Applicable Regions
EU: ESC 2015 guidelines older but similar principles
US: ACC 2025 - IL-1 inhibitors BEFORE corticosteroids
Next steps
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Related Resources
Frequently Asked Questions
What is the Pericarditis Management (ACC 2025)?
The Pericarditis Management (ACC 2025) is a management clinical algorithm for Cardiology. It provides a structured decision tree to guide clinical decision-making, based on 2025 ACC Expert Consensus on Pericarditis.
What guideline is the Pericarditis Management (ACC 2025) based on?
This algorithm is based on 2025 ACC Expert Consensus on Pericarditis (DOI: 10.1016/j.jacc.2025.05.023).
What are the limitations of the Pericarditis Management (ACC 2025)?
Known limitations include: Does not address purulent/tuberculous pericarditis; Immunosuppression protocols simplified; Pericardiectomy criteria not detailed. Individual patient factors may require deviation from these recommendations.
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