When should I consider referring a patient with pericarditis to secondary care?

Consider referring a patient with pericarditis to secondary care if:

• There is diagnostic uncertainty after initial assessment in primary care.
• The patient has severe or persistent symptoms such as chest pain that does not improve with initial management.
• There are signs or symptoms suggestive of complications or more serious underlying cardiac conditions, such as syncope, arrhythmias, or heart failure features.
• There is suspicion of associated valvular heart disease or other structural heart disease requiring specialist evaluation.
• The patient has features that may require urgent specialist assessment, for example, severe symptoms at rest or on minimal exertion.

In these cases, referral to cardiology or secondary care is appropriate to enable further investigations such as echocardiography and specialist management.

This approach aligns with good clinical practice recommendations to refer when diagnosis is unclear or symptoms persist despite initial management, and to consider specialist input for cardiac complications or suspected structural heart disease NICE CKS,NICE CKS,NICE NG208.