EMCRIT
EMCrit - May 24, 2019 - By Meyers P
"It is my opinion that the medical discovery of pericarditis as a disease entity has actually caused overall net harm to human beings. I see and review so many cases in which the notion of “pericarditis” leads to patient harm that it has become a four-letter diagnosis to me. With the exception of extremely rare cases of significant pericardial effusions made hemorrhagic by thrombolytics (only 2 cases) witnessed in an entire career by one of the world's leading experts who reviews thousands of cases around the world), almost no one has any significant complication of uncomplicated pericarditis (unlike myocarditis, complicated pericarditis with significant pericardial effusions, etc.), and whatever small symptomatic benefit true pericarditis patients receive from NSAIDs and/or colchicine is completely overshadowed by the harms of erroneously diagnosing pericarditis.
Pericarditis is almost a wastebasket diagnosis of exclusion, barely more important than costochondritis (and treated in basically the same way). If I were pericarditis, my only reason to exist would be to trick emergency physicians and cardiologists into missing Occlusion MIs and other real pathologic processes. If you correctly diagnose 99 patients with pericarditis and misdiagnose 1 Occlusion MI as pericarditis, you have failed your goal of protecting patients from emergencies. The harm of missing a single Occlusion MI far outweighs the harms of missing pericarditis.
The simplest solution for Emergency Medicine: Just say no to diagnosing uncomplicated pericarditis in the ED..."