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Acute Pericarditis — UKMLA MCQ

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ModerateCardiologyAcute PericarditisUKMLAMRCP Part 1MRCGP AKT

A 45-year-old man is assessed in hospital with sharp central chest pain that is worse on inspiration and when lying flat. A pericardial friction rub is present, and ECG shows widespread concave ST-segment elevation with PR-segment depression. He is haemodynamically stable and afebrile. Troponin is normal and echocardiography shows no pericardial effusion. Renal function is normal, and he has no history of gastrointestinal bleeding or contraindication to colchicine. Which initial drug regimen is most appropriate?

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Correct answer: A — High-dose ibuprofen with colchicine

This is uncomplicated acute pericarditis: typical positional pleuritic pain, a friction rub and diffuse ST elevation with PR depression, without myocardial injury, effusion or haemodynamic compromise. First-line treatment is a high-dose NSAID such as ibuprofen together with colchicine; appropriate gastroprotection should also be considered. Colchicine improves symptom control and reduces recurrence, although its use for pericarditis is off-label in the UK and is commonly initiated by specialist care. Corticosteroids are reserved for specific indications or when NSAIDs and colchicine are contraindicated or ineffective because they may promote recurrence. Antibiotics are required only for bacterial pericarditis. Beta-blockers do not treat pericardial inflammation. Thrombolysis is inappropriate because the diffuse ECG changes and clinical features indicate pericarditis rather than STEMI.

Reference: BMJ Best Practice, Pericarditis, treatment summary, updated 21 January 2026 and evidence reviewed 11 July 2026, https://www.medicines.org.uk/emc/product/14362/smpc