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Acute Pericarditis — RACP Adult Medicine MCQ

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EasyCardiologyAcute PericarditisRACP Adult Medicine

A 35-year-old man presents with pleuritic chest pain worse on lying flat and relieved by sitting forward. He has a pericardial friction rub. ECG shows diffuse ST elevation with PR depression. CRP is 85 mg/L. Echo shows a small pericardial effusion with no tamponade. What is the most appropriate treatment?

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Correct answer: D — Colchicine plus ibuprofen

Acute pericarditis without tamponade or high-risk features is treated with colchicine (0.5 mg BD for 3 months) plus NSAIDs (ibuprofen 600 mg TDS for 1–2 weeks, then taper). The COPE and ICAP trials demonstrated colchicine reduces recurrence by ~50%. Corticosteroids should be avoided first-line as they increase recurrence risk. Restrict exercise until symptoms resolve and CRP normalises.

Reference: ESC – 2015 – Pericardial Disease Guidelines; eTG Cardiovascular 2024