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Pericarditis Complication Screening — RACP Adult Medicine MCQ

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EasyCardiologyPericarditis Complication ScreeningRACP Adult Medicine

A 40-year-old man presents with pleuritic chest pain and low-grade fever. ECG shows PR depression in multiple leads and widespread concave ST elevation. His troponin is 45 ng/L (mildly elevated). CRP is 85 mg/L. A recent upper respiratory tract infection preceded his symptoms by 1 week. What is the most important investigation to exclude a complication?

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Correct answer: C — Cardiac MRI

In acute pericarditis (widespread ST elevation with PR depression, preceding viral illness), echocardiography should be performed to assess for pericardial effusion and any haemodynamic compromise (tamponade). While most cases of acute pericarditis have small or no effusions, moderate-large effusions can develop, particularly in viral or autoimmune pericarditis. Echocardiography guides the need for pericardiocentesis. The mildly elevated troponin indicates myopericarditis but does not change the immediate management (NSAIDs + colchicine).

Reference: eTG – 2025 – Cardiovascular; ESC – 2015 – Pericardial Diseases Guidelines