Recurrent pericarditis represents the most challenging complication of acute pericarditis and has a significant impact on patients' quality of life. It is defined by the occurrence of a new episode after complete remission and should be distinguished from incessant pericarditis, in which symptoms persist without clinical remission. The causes are often idiopathic, likely post-viral or related to autoimmune/autoinflammatory mechanisms, but also include forms secondary to systemic diseases, interventional procedures, or, more rarely, malignancies. The diagnosis is based on the criteria for acute pericarditis applied to a recurrent episode, supported by biomarkers and multimodality imaging. First-line treatment consists of non-steroidal anti-inflammatory drugs or high-dose aspirin combined with colchicine and restriction of physical activity. Corticosteroids are reserved for selected cases and should be used at low doses with very gradual tapering. In refractory or corticosteroid-dependent patients, interleukin-1 inhibitors have revolutionized management, significantly reducing recurrences in forms with an inflammatory phenotype. Prognosis is generally favorable in idiopathic forms but requires structured follow-up and personalized therapeutic strategies. In this article, we address the most common clinical questions regarding recurrent pericarditis, aiming to translate current guideline recommendations into everyday clinical practice.

Acute Pericarditis as an Unusual Presentation of Disseminated Donor-Derived Tuberculosis in a Lung Transplant Recipient

Acute pericarditis is an uncommon complication of thermal atrial fibrillation (AF) ablation, whereas milder pericardial inflammatory symptoms, typically pleuritic or positional chest pain, are more common and negatively affect post-procedural recovery. Pulsed field ablation (PFA), a non-thermal modality with tissue-selective properties, may reduce collateral pericardial injury. We compared post-procedural pericardial inflammatory symptoms and recovery after AF ablation using PFA vs. radiofrequency ablation (RFA). This single-center observational study with prospective data collection included 150 patients undergoing catheter ablation for paroxysmal or persistent AF using focal PFA (n = 75) or RFA (n = 75). Patients were identified from the procedural workflow during the study period. Post-procedural pericardial inflammatory symptoms, chest pain severity (5-point scale), anti-inflammatory therapy use, length of hospital stay, and biomarkers of inflammation (CRP) and myocardial injury (hs-TnT) were assessed during hospitalization and structured post-discharge follow-up. Baseline characteristics were similar between groups. Post-procedural chest pain occurred more frequently after RFA than PFA (32% vs. 5.3%, p < 0.001), despite a significantly greater proportion of patients in the PFA group receiving lesion sets beyond pulmonary vein isolation (94.7% vs. 73.3%, p < 0.001). Anti-inflammatory therapy was prescribed more frequently after RFA (20% vs. 2.7%, p = 0.001), and hospital length of stay was longer [2 (1-2) vs. 1(1-1) days, p = 0.03). Procedure duration was shorter with PFA (86 ± 36 vs. 122 ± 55 min, p < 0.001). Median hs-TnT levels were higher after PFA [1288 (865-2137) vs. 1001 (652-1368] ng/L, p = 0.01), whereas CRP levels were similar [10.4 (4.9-23.3) vs. 10.5 (6.9-27.3) mg/L; p = 0.38]. PFA was associated with fewer post-procedural pericardial inflammatory symptoms, reduced need for anti-inflammatory therapy, and faster recovery compared with RFA. These findings suggest reduced pericardial irritation and improved patient-centered recovery after AF ablation.

Pericardial disease represents a diverse clinical spectrum, including acute pericarditis, pericardial effusion, cardiac tamponade, effusive-constrictive pericarditis, and constrictive pericarditis, which vary significantly in presentation, urgency, and management. Recent consensus guidelines from the European Society of Cardiology and the American College of Cardiology have enhanced clinical phenotyping, multimodal imaging techniques, and targeted immunomodulatory therapies; however, their implementation in clinical practice remains variable. We introduce our updated pathway-based framework that structures diagnosis and treatment around five key clinical scenarios: chest pain, hemodynamic collapse, dyspnea, incidental pericardial effusion, and right-sided heart failure. Each scenario guides a systematic process of risk stratification, tiered diagnostic evaluation, and phenotype-specific therapy. In cases of acute pericarditis, management employs a three-tier escalation approach, with interleukin-1 inhibitors (rilonacept, anakinra) as the preferred escalation for inflammatory phenotypes unresponsive to NSAIDs and colchicine. Cardiac magnetic resonance imaging is integral to phenotyping, utilizing late gadolinium enhancement and T2-STIR sequences to inform treatment escalation. Management of pericardial effusion is standardized through a validated drainage scoring system that considers etiology, size, and echocardiographic hemodynamics. Constrictive pericarditis is classified into three subtypes: transient/inflammatory, effusive-constrictive, and chronic/fixed, each with a distinct management pathway, reserving surgical pericardiectomy at specialized centers for fibrotic or medically refractory cases. This pathway consolidates current evidence into a reproducible clinical framework designed to standardize care, enhance diagnostic precision, and facilitate shared decision-making among multidisciplinary pericardial disease teams.

Climate change is a major factor influencing cardiovascular health, yet its impact on diverse cardiac conditions in East Asia remains insufficiently explored. This study investigated associations between meteorological factors and cardiac morbidity in 3 South Korean cities-Seoul, Busan, and Daejeon-using monthly administrative data from 2010 to 2023. Generalized additive models were employed to assess the effects of temperature, precipitation, and extreme weather indicators on acute pericarditis and heartbeat abnormalities. The results revealed distinct city-specific sensitivities: in Seoul, heatwave days were positively associated with increased pericarditis visits, while in Busan, more frequent precipitation days were linked to higher risks of heartbeat abnormalities. Furthermore, relative humidity emerged as a significant factor, with lower humidity levels correlating with increased pericarditis in Seoul and Daejeon, and higher humidity associated with elevated heartbeat abnormality risks in Seoul. Our results indicate that urban cardiovascular vulnerability involves a complex interplay of thermal and hygrometric stressors that varies by city. These findings highlight the importance of weather factors beyond temperature alone, suggesting the necessity of considering city-specific climate patterns in epidemiological monitoring.

Colchicine in cardiovascular medicine: Current perspectives on mechanisms and clinical therapeutics.

Myocarditis and perimyocardial syndromes share overlapping features but differ in management. Differentiating them in children presenting with chest pain or palpitations remains difficult, particularly in non-fulminant cases. This study evaluated the diagnostic value of inflammatory biomarkers, especially the Systemic Immune-Inflammation Index (SII), in distinguishing perimyocardial syndromes from isolated myocarditis in the pediatric emergency department (PED). We retrospectively analyzed patients aged 1-18 years diagnosed with myocarditis, perimyocardial syndromes, or acute pericarditis between 2015 and 2021. Clinical characteristics, laboratory, ECG and echo findings of all patients were recorded. SII was calculated using neutrophil, platelet, and lymphocyte counts obtained within six hours of PED admission. ROC analysis assessed diagnostic performance. 166 eligible subjects were enrolled (74 cases of myocarditis, 63 cases of myopericarditis, 21 cases of perimyocarditis, and 8 cases of acute pericarditis). The median age was 15 (12-17) years, and 76.5% of the patients were male. The median WBC, ANC and SII were respectively 7.44 (IQR 6.22-9.32), 3.93 (IQR 3.38-5.00), and 418 (IQR 286-679) in the myocarditis and significantly lower than the other groups (p < 0.001). In estimation of perimyocardial syndromes, AUC was 0.735 for WBC, 0.805 for ANC, 0.803 for SII (p < 0.001). The optimal cut-off values determined by the Youden Index were 8.24(x109/L) for WBC, 4.85(x109/L) for ANC, and 693 for SII, with corresponding sensitivities of 67.4%, 76.1%, and 73.9%, and specificities of 61.6%, 67.1%, and 75.3%, respectively. SII and ANC are useful, accessible biomarkers for differentiating perimyocardial syndromes from myocarditis. Their integration into early diagnostic strategies may support efficient triage and decision-making in the PED.

Despite being a common reason for Emergency Department (ED) admission, information about the management of acute pericarditis is limited in this setting. In this retrospective study conducted at the ED of Ospedale di Circolo in Varese (Italy) from 2019 to 2023, patients with acute pericarditis were included. The primary endpoint was the occurrence of the 12-month composite outcome (treatment failure, recurrent pericarditis, cardiac tamponade, constrictive pericarditis or death). One-hundred and sixty-nine patients were included (median age 54 years, 65.1% males). Chest pain was the main symptom (96.4%). On admission, aspirin was more frequently given over non-steroidal anti-inflammatory drugs (NSAIDs), and colchicine was prescribed in 40% of patients. At discharge, more patients were prescribed ibuprofen, and colchicine prescription significantly increased to 71%. Drug doses were compliant with guidelines in a limited number of patients at admission and increased at discharge. The composite outcome occurred in 20.1% of patients (n = 34), mainly driven by recurrences (n = 18) and treatment failure. Patients with a complicated course were older, of female sex, with a larger proportion of comorbidities and higher CRP levels. Diabetes (HR 3.9, 95% CI 1.7-9.1), COPD (HR 6.2, 95% CI 2.3-17.1), recent percutaneous cardiac procedures (HR 6.5, 95% CI 2.1-19.6), and recent SARS-CoV-2 vaccination (HR 3.0, 95% CI 1.1-8.2) were independent risk factors for the composite outcome. A significant proportion of patients with acute pericarditis experience long-term complications. Sub-optimal adherence to guideline-recommended doses of anti-inflammatory drugs was commonly observed, suggesting an area for improvement in the management of these patients.

Cardiac vasculitis represents a heterogeneous group of immune-mediated disorders that can involve the coronary vessels, myocardium, valvular apparatus and pericardial tissues. Despite its rarity, cardiac vasculitis may result in significant clinical sequelae such as acute coronary syndrome, heart failure, cardiac arrhythmias and pericarditis. Diagnosis is challenging because symptoms are often non-specific and overlap with other cardiovascular conditions. Early recognition is therefore crucial to prevent delayed treatment and disease progression. Advances in non-invasive multimodality imaging and collaborative cardio-rheumatology care have transformed recognition and management of this disease spectrum. Emerging techniques such as hybrid positron emission tomography-cardiac MRI and quantitative CT imaging permit in-vivo characterisation of inflammation. As per European Alliance of Associations for Rheumatology recommendations, treatment requires early intensive immunosuppression to induce remission, coupled with comprehensive cardiovascular risk management. Additional research is required to validate imaging-guided management algorithms, refine vasculitis-specific cardiovascular risk and define long-term outcomes across disease subtypes.

Colchicine in addition to usual care for acute pericarditis with classical ECG changes after catheter ablation for cardiac arrhythmias.

Therapeutic management of inflammatory heart diseases.

26-CVT-10433-ACC EFFICACY OF COLCHICINE MONOTHERAPY COMPARED TO COMBINATION THERAPY WITH COLCHICINE ADDED AS ADJUNCTIVE THERAPY IN ACUTE PERICARDITIS

Innate and Adaptive Immune Mechanisms in Pericarditis: Pathobiology and Clinical Implications.

Background/Objectives: Childhood-onset Sjögren disease (cSjD) is a rare autoimmune disorder with heterogeneous manifestations and ongoing diagnostic challenges, as there are no validated paediatric criteria. Our study aims to characterise the clinical, laboratory, and imaging features of children diagnosed with cSjD at a single Romanian paediatric rheumatology centre between 2015 and 2025 and contextualise these findings within the most recent literature. Methods: A retrospective review of 15 consecutive cSjD patients was conducted, including clinical features, autoantibodies, imaging, biopsy findings, treatment, and outcomes. Results: Our cohort showed a significant female predominance (80%) and a broad age range at disease onset (3-15 years). Extraglandular manifestations were more common at presentation than glandular phenotypes (53.3% vs. 40%). Lupus-like extraglandular presentations frequently led to initial misdiagnosis as childhood-onset systemic lupus erythematosus (SLE) in our cohort. Sicca symptoms were present at diagnosis in only 3 of 15 patients (20%) and developed later during follow-up in an additional 4 patients (26.7%). Notably, the cohort included novel findings, such as an unprecedented presentation with acute exudative pericarditis complicated by cardiac tamponade. Anti-SSA antibodies and salivary gland ultrasound abnormalities were highly prevalent (86.7% and 100%, respectively). Anti-SSB antibodies were detected in seven patients (46.7%), with titres showing more variability than those of anti-SSA, ranging from just above the positivity threshold to mildly elevated levels. The association with macro-creatine kinase type I was another distinctive feature of this series. Chronic musculoskeletal pain and dryness were our patients' most frequently reported symptoms at the last assessment, affecting up to 5/15 (33.3%) in each domain. One patient showed irreversible ocular damage during our study. Conclusions: Extraglandular presentations of cSjD are highly heterogeneous and diagnostically challenging, often occurring without glandular symptoms. Lupus-like systemic features-including facial vasculitic purpura, with or without arthralgia, and occasional pericarditis, as observed in our cohort-may contribute to frequent initial diagnostic misattribution to SLE. Early salivary gland ultrasonography, targeted autoantibody testing, and selective biopsy are essential for timely diagnosis, underscoring the urgent need for paediatric-specific validated classification criteria.

Idiopathic pericarditis in 2025: Advances in diagnosis and therapeutic strategies.

Summary: Pericarditis is a relatively uncommon condition in emergency settings but is frequently encountered in cardiology. Viral infections are the most common cause, though it can also result from autoimmune conditions, cancer, and, in this case, trauma. A 70-year-old male patient attended the emergency department with sudden-onset, sharp, pleuritic, central chest pain. The patient reported having a fishbone stuck in his throat earlier in the day, which he had swallowed with food boluses and was pain-free after. Assessment revealed signs consistent with pericarditis, with diffuse ST segment elevation on electrocardiogram. Blood tests showed elevated inflammatory markers and negative Troponin T. A diagnosis of acute pericarditis was made, and the patient was admitted to cardiology for workup and treatment. A computed tomography (CT) scan of the thorax, abdomen, and pelvis was performed, given his persistent pain despite analgesia. It showed a foreign body at the mid-lower thoracic oesophagus, perforating through the anterior and posterior walls with surrounding inflammatory changes, with moderate low-density pericardial effusion with features of pericarditis. Emergency esophagogastroscopy was arranged, together with repair of the perforations with surgical clips by General Surgery. The patient recovered uneventfully and was discharged after one week. An interval CT Thorax was done in the outpatient setting six weeks post-discharge, showed no mediastinal collection or pneumomediastinum, and an interval decrease in size of the pericardial effusion. While viral infections remain the top cause of pericarditis, this case highlights the importance of maintaining a broad differential diagnosis of etiologies when diagnosing pericarditis. This necessitates thorough history taking and a low threshold for CT imaging, especially in older patients without preceding respiratory symptoms, immunosuppression, or known autoimmune conditions, to uncover atypical causes. Early identification and intervention are crucial to prevent complications and ensure favorable patient outcomes.

Purulent pericarditis is a rare occurrence in the era of modern antibiotics. It is most often caused by organisms such as Staphylococcus aureus, Streptococcus pneumoniae, Viridans streptococci, Haemophilus influenzae and anaerobic bacteria with Streptococcus pyogenes (S. pyogenes) being a possible, though very uncommon etiology. This case represents an occurrence of S. pyogenes pericarditis in an apparently healthy female with no known immunocompromising condition. A 37-year-old female, married, real estate agent with no comorbidities came in for chest pain radiating to the upper back, relieved with leaning forward. Cardiac biomarker was normal, ECG demonstrated diffuse ST-segment elevation and PR segment depression, while imaging showed lobar pneumonia. Blood tests showed leukocytosis with neutrophilic predominance and workup for immunocompromised state was negative. The 2D echo showed large pericardial effusion with tamponade physiology. An urgent pericardiocentesis was done. Cultures grew Streptococcus pyogenes confirming the diagnosis of acute purulent pericarditis. Daily drainage of pericardial effusion, colchicine, ibuprofen was initiated together with antibiotics and the patient had resolution of pericardial effusion. Acute pyogenic pericarditis with cardiac tamponade is a rare but serious condition that requires prompt recognition and intervention. Early diagnosis, through a combination of clinical suspicion, ECG and echocardiography is crucial for initiating timely treatment. Keywords: Acute purulent pericarditis, cardiac tamponade, pericardial effusion, S. pyogenes, case report

BACKGROUND: Acute pericarditis is a rare diagnosis among emergency department (ED) patients with chest pain, and how race and sex jointly influence risk remains poorly characterized. We evaluated race–sex heterogeneity in acute pericarditis risk using interaction-based and marginal analytic approaches. METHODS: This retrospective cohort study utilized patient-level electronic health records from 10 EDs in a large integrated health system (2016–2022). Adult patients (≥ 18 years) self-identifying as non-Hispanic Black or non-Hispanic White and presenting with chest pain were included. Acute pericarditis was identified using International Classification of Diseases, Tenth Revision codes I30.x, supported by clinical documentation. Generalized linear models with log link and robust variance estimated risk ratios (RRs) for race, sex, and their interaction. Because interaction models yield conditional coefficients, inference focused on race–sex contrasts and on marginal predicted probabilities derived from recycled prediction methods. RESULTS: Among 114,517 ED chest pain visits, 346 (0.30%) met criteria for acute pericarditis, including n = 151 non-Hispanic Black patients and n = 195 non-Hispanic White patients. Evidence of race–sex effect modification was observed. Compared with non-Hispanic White women, non-Hispanic Black men had a statistically significantly higher adjusted risk of acute pericarditis (RR = 1.72; 95% CI, 1.10–2.69). Marginal estimates indicated higher adjusted predicted risk among men across both racial groups, with the highest absolute and relative risks among non-Hispanic Black men. Results from sensitivity analyses excluding the COVID-19 period were similar. CONCLUSION: Despite the rarity of the disease, acute pericarditis has clinically significant heterogeneity among race–sex subgroups. Marginal estimates based on interaction suggest that non-Hispanic Black men have the highest risk, suggesting the utility of intersectional demographic analysis in ED chest pain triage.

Background: Myocarditis is a potentially life-threatening inflammation of the myocardium that can be triggered by viral infections, including influenza. While corticosteroids have historically been used with caution in viral myocarditis due to concerns over impaired viral clearance, recent insights—particularly those emerging from the COVID-19 pandemic—suggest that early, moderate-dose corticosteroid therapy may offer clinical benefits in selected inflammatory cardiac syndromes. This study aimed to assess the incidence and clinical features, as well as short-term outcomes of influenza-related myocarditis and/or pericarditis. Methods: A retrospective, observational study was conducted, including all consecutive patients diagnosed with acute myocarditis and/or pericarditis between December 2024 and March 2025 who presented with chest pain or dyspnea and had a confirmed Influenza A (H1N1) infection. The diagnostic evaluation included cardiac biomarkers, ECG, TTE, and cardiovascular magnetic resonance (CMR). All patients were monitored during a three-month follow-up period. Results: Of 281 patients with laboratory-confirmed H1N1 infection, six (2%) were diagnosed with myocarditis and/or pericarditis. All patients diagnosed with myocarditis received corticosteroid therapy and an antiviral drug (oseltamivir). CMR confirmed the diagnosis in all cases of inflammatory cardiomyopathy. At 30 days, median LVEF improved from 49% to 58%. No deaths or rehospitalizations were reported. Conclusions: Influenza-related myocarditis and/or pericarditis are relatively uncommon, occurring in approximately 2% of cases. When they occur, they are primarily associated with an uncomplicated clinical course and with favourable short-term outcomes, including a rapid recovery of left ventricular function and the absence of adverse events at three-month follow-up.

Electroconvulsive Therapy in a Patient With Schizophrenia and Acute Pericarditis: A Case Report.