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Pericarditis Management (ACC 2025)

Pericarditis Management (ACC 2025): Acute Pericarditis → First-Line: Dual Anti-inflammatory → Activity Restriction.

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. Start

    Acute Pericarditis

    ≥2 of: pleuritic pain, friction rub, ECG changes, effusion

    1. 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
      1. Action

        Activity Restriction

        Minimum 1 month

        • Avoid strenuous exercise
        • Athletes: 3 months
      2. Decision

        Response to First-Line?

        If Yes:

        1. Outcome

          Resolved

          Complete colchicine course

          1. Outcome

            Follow-Up

            Echo, inflammatory markers, symptom monitoring

        If No:

        1. Warning

          Refractory/Recurrent

          2025 Update: IL-1 inhibitors BEFORE steroids

          1. 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
            1. Warning

              Pericardiectomy

              Refractory or constrictive

          2. 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

pediatric

Applicable Regions

USEU

EU: ESC 2015 guidelines older but similar principles

US: ACC 2025 - IL-1 inhibitors BEFORE corticosteroids

Version 1Next review: 2028-06-01

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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