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Acute pericarditis — MRCEM SBA MCQ

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EasyCardiovascular emergenciesAcute pericarditisMRCEM SBA

A 34-year-old man presents with two days of sharp central chest pain that worsens on inspiration and when lying flat, and improves when he leans forward. His temperature is 38.6°C, blood pressure 126/78 mmHg and pulse 104/min. The ECG shows widespread concave ST elevation with PR depression and no reciprocal ST depression. High-sensitivity troponin is within the laboratory reference range. Echocardiography shows no pericardial effusion. Renal function is normal, and he has no contraindication to anti-inflammatory treatment. Which initial treatment and disposition plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Admit; start ibuprofen and colchicine.

The positional, pleuritic pain together with widespread ST elevation and PR depression supports acute pericarditis. His normal troponin and absence of an effusion are reassuring, but they do not override the disposition decision: a temperature above 38°C is a major adverse prognostic feature in UK emergency-department guidance, which recommends admission. With normal renal function and no stated contraindication, initial anti-inflammatory treatment is ibuprofen with adjunctive colchicine; gastric protection should also be considered when prescribing the NSAID. ([gloshospitals.nhs.uk](https://www.gloshospitals.nhs.uk/media/documents/Acute_pericarditis_management_in_the_ED_agnDJgY.pdf)) B offers appropriate medicines but misses the admission indication. C offers analgesia and an NSAID, but omits colchicine, which is recommended as an adjunct for acute pericarditis. D omits the first-line aspirin or NSAID despite no contraindication. E correctly retains admission and colchicine, but corticosteroids are not the appropriate initial substitute for an NSAID in this patient; they may be considered when aspirin or NSAIDs are contraindicated or have failed, after relevant infectious causes have been excluded. ([gloshospitals.nhs.uk](https://www.gloshospitals.nhs.uk/media/documents/Acute_pericarditis_management_in_the_ED_agnDJgY.pdf))

Reference: Acute Pericarditis—ED Guidance (June 2018; review date June 2020) — https://www.gloshospitals.nhs.uk/media/documents/Acute_pericarditis_management_in_the_ED_agnDJgY.pdf Colchicine for pericarditis pain: Prescribing information for primary care (Approved February 2020; review date February 2023) — https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Colchicine-for-pericarditis-info-sheet-for-GPs-V6-approved.pdf