Which investigations should be prioritized in a patient with suspected acute pericarditis?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Investigations to prioritize in suspected acute pericarditis include:

  • Resting 12-lead ECG: To identify characteristic changes such as widespread ST-segment elevation and PR depression, and to exclude other causes of chest pain like acute coronary syndrome .
  • Blood tests: Including inflammatory markers (e.g., CRP, ESR), full blood count, and cardiac biomarkers (troponin) to assess for myocardial involvement and inflammation .
  • Chest X-ray: To exclude alternative diagnoses such as pneumonia, pneumothorax, or complications like pleural effusion ,.
  • Echocardiography: To assess for pericardial effusion and cardiac function, which is important to identify complications such as cardiac tamponade .

These investigations help confirm the diagnosis of acute pericarditis, exclude other serious causes of chest pain, and identify complications requiring urgent management ,,.

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