Diagnostic criteria for acute pericarditis and myopericarditis in the clinical setting

Acute pericarditis (at least two criteria of four should be present)*:

1. Typical chest pain

2. Pericardial friction rub

3. Suggestive ECG changes (typically widespread ST segment elevation)

4. New or worsening pericardial effusion

Myopericarditis:

1. Definite diagnosis of acute pericarditis, PLUS

2. Suggestive symptoms (dyspnea, palpitations, or chest pain) and ECG abnormalities beyond normal variants, not documented previously (ST/T abnormalities, supraventricular or ventricular tachycardia or frequent ectopy, atrioventricular block), OR focal or diffuse depressed LV function of uncertain age by an imaging study

3. Absence of evidence of any other cause

4. One of the following features: Evidence of elevated cardiac enzymes (creatine kinase-MB fraction, or troponin I or T), OR new onset of focal or diffuse depressed LV function by an imaging study, OR abnormal imaging consistent with myocarditis (MRI with gadolinium, gallium-67 scanning, anti-myosin antibody scanning)

Case definitions for myopericarditis include:

Suspected myopericarditis: Criteria 1 plus 2 and 3

Probable myopericarditis: Criteria 1, 2, 3, and 4

Confirmed myopericarditis^¶: Histopathologic evidence of myocarditis by endomyocardial biopsy or on autopsy

ECG: electrocardiogram; LV: left ventricular; MRI: magnetic resonance imaging.
* Pericardial effusion confirms the clinical diagnosis, but its absence does not exclude it.
¶ In clinical practice, a confirmed diagnosis would require an endomyocardial biopsy that is not warranted in self-limited cases with predominant pericarditis.

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Diagnostic criteria for acute pericarditis and myopericarditis in the clinical setting