16 y/o female with no significant past medical history presents with sharp/pleuritic chest pain which improves when sitting up and leaning forward. EKG demonstrates changes consistent with pericarditis. Does this patient have pericarditis? If so, what is the work up?

Yes, she has pericarditis.  Acute pericarditis is diagnosed by the presence of at least two of the following four criteria:

1. typical chest pain
2. suggestive changes on the EKG 
3. pericardial friction rub 
4. new or worsening pericardial effusion

Workup includes:

• EKG
• chest x-ray 
• cbc, troponin, ESR, CRP
• echo
• if febrile, blood cultures
• if on coumadin or at risk of coagulopathy,  INR/PT/PTT

Purpose of workup is to identify pericarditis patients at high risk of tamponade (ie malignancy, TB, purulent pericarditis, anticoagulation, large pericardial effusion greater than 20 mm) and arrhythmia (ie patients with concomitant myocarditis as suggested by an elevated troponin or new ventricular systolic dysfunction).   High risk patients should be admitted to the hospital for further evaluation. 


Source

 Imazio, M. "Clinical presentation and diagnostic evaluation of acute pericarditis"  Up to Date.  Jan 2012.