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Pericarditis — ABIM Board MCQ

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EasyCardiovascularPericarditisABIM Board

A 36-year-old man develops sharp, pleuritic chest pain after a viral syndrome. The pain improves when he sits forward. He is afebrile and hemodynamically stable. ECG shows diffuse ST-segment elevation and PR-segment depression, and serum troponin is normal. Echocardiography shows a small pericardial effusion without tamponade physiology. Kidney function is normal, and he has no contraindication to nonsteroidal anti-inflammatory drugs or colchicine. Which of the following is the most appropriate initial management?

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Correct answer: B — High-dose ibuprofen plus colchicine

This patient has uncomplicated acute pericarditis, supported by characteristic positional pleuritic pain, diffuse ST-segment elevation with PR depression, and a small pericardial effusion. First-line treatment is a high-dose NSAID, such as ibuprofen, combined with colchicine; colchicine improves treatment response and reduces recurrence. Strenuous exercise should also be restricted until the clinical inflammation resolves. Prednisone is generally reserved for contraindication or inadequate response to first-line treatment or for a specific indication such as systemic autoimmune disease because early corticosteroid use increases recurrence risk. Pericardiocentesis is indicated for tamponade or selected large, symptomatic, or diagnostically concerning effusions, not a small stable effusion. Warfarin does not treat pericardial inflammation and may increase bleeding risk. Antibiotics are appropriate only when bacterial or purulent pericarditis is suspected.

Reference: American College of Cardiology. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis, management section, 2025. https://www.acc.org/latest-in-cardiology/journal-scans/2025/08/05/19/05/new-concise-clinical