Acute Pericarditis

Sharp chest pain that worsens with inspiration or lying flat and eases when the patient sits forward should raise suspicion for pericardial inflammation. That pattern is useful, but it does not exclude acute coronary syndrome; the initial assessment must still include vital signs, a 12-lead ECG, and prescribed cardiac biomarkers. The immediate clinical question is not only, “Is this pericarditis?” It is, “Has inflammation produced an effusion that is now limiting cardiac filling?” A slowly accumulating effusion may be tolerated, whereas a rapidly enlarging one can compress the right-sided chambers, reduce venous return, and cause cardiac tamponade. The RPN therefore watches both the inflammatory picture and the patient’s perfusion.