Pericarditis, Myocarditis, Pericardial Effusion & Tamponade
Differentiate inflammatory cardiac syndromes from ACS and rapidly recognize hemodynamically significant pericardial disease.
Module format: each study session covers what to learn, how the presentation appears clinically, investigation/management priorities, safety issues and common MCCQE traps.
Module 7 — Topic map
- Acute pericarditis: characteristic pain, ECG changes and common etiologies
- Initial treatment of uncomplicated pericarditis and recurrence prevention concepts
- Pericardial effusion: causes, clinical evaluation and echocardiographic assessment
- Cardiac tamponade: hypotension, elevated JVP, pulsus paradoxus and urgent drainage
- Constrictive pericarditis and differentiation from restrictive cardiomyopathy/right HF
- Myocarditis: infectious/inflammatory causes, presentation, troponin/ECG/echo clues and activity restriction
- Myopericarditis and when to suspect arrhythmia or heart-failure complications
Acute CareAssessment / DiagnosisEmergency managementChest-pain differential
Study Session 7.1 — Acute Pericarditis
Focused MCCQE cardiovascular study session
Core topics & learning goals
- Recognize pleuritic/positional chest pain, friction rub and diffuse ECG changes.
- Differentiate pericarditis from STEMI and early repolarization.
- Identify common viral/idiopathic, post-MI, renal, malignant and autoimmune causes.
- Recognize high-risk features that warrant admission or broader workup.
Clinical recognition & investigation
- Assess for effusion/tamponade and myocardial involvement.
- Use inflammatory markers and echo selectively.
Management & patient-safety priorities
- Treat uncomplicated cases with anti-inflammatory therapy plus recurrence-prevention strategy when appropriate.
- Restrict strenuous activity until clinically resolved.
MCCQE exam traps
- Localized ST elevation with reciprocal change favors MI rather than typical diffuse pericarditis.
- Avoid anticoagulation decisions without considering effusion/bleeding context.
Study Session 7.2 — Pericardial Effusion, Tamponade & Constriction
Focused MCCQE cardiovascular study session
Core topics & learning goals
- Recognize tamponade physiology: hypotension, elevated JVP, tachycardia, pulsus paradoxus and echo findings.
- Know causes of large/recurrent effusions.
- Differentiate constrictive pericarditis from restrictive cardiomyopathy conceptually.
- Understand that tamponade can occur without the full classic triad.
Clinical recognition & investigation
- Use bedside ultrasound/echo in unstable patients.
- Recognize electrical alternans as a possible but nonrequired clue.
Management & patient-safety priorities
- Urgent pericardial drainage for hemodynamically significant tamponade.
- Treat underlying cause and refer recurrent/constrictive disease.
MCCQE exam traps
- Do not wait for every classic sign before treating unstable tamponade.
- Positive-pressure ventilation can worsen preload-dependent tamponade physiology.
Study Session 7.3 — Myocarditis & Myopericarditis
Focused MCCQE cardiovascular study session
Core topics & learning goals
- Recognize viral/prodromal symptoms followed by chest pain, HF or arrhythmia.
- Interpret troponin, ECG and echo findings in context.
- Differentiate myocarditis from ACS, especially in younger patients.
- Recognize fulminant myocarditis and cardiogenic shock.
Clinical recognition & investigation
- Ask about infections, immune therapies, toxins and systemic inflammatory disease.
- Use cardiac MRI/specialist testing when indicated rather than as first stabilization step.
Management & patient-safety priorities
- Treat HF/arrhythmias supportively and avoid strenuous exercise during recovery.
- Escalate unstable patients for advanced support.
MCCQE exam traps
- Troponin elevation does not prove ACS.
- NSAID use is not automatically appropriate for isolated myocarditis without pericarditis.