Clinical Commander

All dossiers
cardio.pericarditis.core.v1

Pericarditis (acute / recurrent / IMPS)

cardiologyacutesubacutechronicadultacuteoutpatienttransition
Start encounter →Print handoutPRODUCTION

4-step regimen ladder (NSAID + colchicine → recurrent extended → IL-1 blockade → etiology-specific) authored without RxCUIs (atoms file pending RxNav lookup); outpatient + transition + ED setting playbooks; six severity triggers including tamponade, myopericarditis, refractory recurrent, TB/bacterial, constrictive evolution, autoimmune. No `_design-brief.md` in src/lib/tier3/problem-package/packages/pericarditis — author one before promoting to PRODUCTION. Manifest cites COPE, ICAP, CORP, CORP-2, AIRTRIP, RHAPSODY (Klein NEJM 2021), 2025 ESC Pericarditis IMPS — without inline PMIDs; backfill on next research pass.

Entry points (5)

  • symptom
    Pleuritic / positional chest pain (ACC/AHA 2022)
    pleuritic_chest_pain
  • symptom
    Pericardial friction rub on auscultation (ACC/AHA 2022)
    pericardial_rub
  • imaging
    ECG: diffuse ST elevation + PR depression (ACC/AHA 2022)
    ecg_diffuse_st_pr
  • imaging
    Pericardial effusion on echo (ACC/AHA 2022)
    echo_pericardial_effusion
  • lab_abnormality
    CRP/ESR elevated as supportive evidence (ACC/AHA 2022)
    crp_esr_elevated

Required inputs (13)

  • agerequired
    demographic • used at CONTEXT
    Age + first vs recurrent class affects dose / taper (ACC/AHA 2022)
  • sbprequired
    vital • used at RED_FLAGS
    Tamponade physiology screen (Beck triad) (ACC/AHA 2022)
  • hrrequired
    vital • used at CONTEXT
    Tachycardia from inflammation / tamponade (ACC/AHA 2022)
  • ecgrequired
    imaging • used at INITIAL_WORKUP
    Diffuse ST↑ + PR↓ supports diagnosis (≥2 of 4 ESC criteria)
  • echorequired
    imaging • used at INITIAL_WORKUP
    Detect effusion + tamponade (ACC/AHA 2022)
  • cmr
    imaging • used at BRANCHING_WORKUP
    Confirm myocardial involvement (myopericarditis); fibrosis pattern (ACC/AHA 2022)
  • troponinrequired
    lab • used at INITIAL_WORKUP
    Myopericarditis screen (RHAPSODY uses CRP+CMR+troponin) (ACC/AHA 2022)
  • crprequired
    lab • used at INITIAL_WORKUP
    Diagnostic + treatment-response biomarker (ACC/AHA 2022)
  • creatininerequired
    lab • used at TREATMENT
    Colchicine/NSAID dose adjustment (ACC/AHA 2022)
  • recent_viral_illness
    history • used at CONTEXT
    Most common idiopathic / viral etiology (ACC/AHA 2022)
  • recent_mi_or_cardiac_surgery
    history • used at CONTEXT
    Dressler / post-pericardiotomy syndrome (ACC/AHA 2022)
  • autoimmune_or_uremia
    history • used at CONTEXT
    SLE / RA / vasculitis / uremic pericarditis (ACC/AHA 2022)
  • malignancy
    history • used at CONTEXT
    Neoplastic pericardial disease (ACC/AHA 2022)

12-phase flow (11)

  1. 1FRAME
    Acute (<4–6 wk), incessant (4–12 wk), recurrent (≥1 month-free interval), chronic; IMPS framework (ACC/AHA 2022)
    advance: class assigned
  2. 2ENTRY
    ≥2 of 4 ESC criteria: pleuritic pain, rub, ECG, effusion (+ supportive CRP/ESR)
    inputs: ecg
    advance: criteria met
  3. 3CONTEXT
    Etiology screen (idiopathic / viral / TB / autoimmune / uremic / neoplastic / Dressler / drug) (ACC/AHA 2022)
    inputs: recent_viral_illness, recent_mi_or_cardiac_surgery, autoimmune_or_uremia, malignancy
    advance: etiology context complete
  4. 4RED_FLAGS
    Tamponade (Beck / pulsus); large effusion; high-fever bacterial / TB pericarditis; significant troponin rise (myopericarditis) (ACC/AHA 2022)
    inputs: sbp, troponin
    actions: cardiac_tamponade
    advance: tamponade + bacterial/TB / myocardial flagged
  5. 5INITIAL_WORKUP
    ECG, echo, CRP / ESR, troponin, CBC, BMP; CXR; targeted etiology labs (TSH, ANA, urea, HIV, viral if severe) (ACC/AHA 2022)
    inputs: ecg, echo, crp, troponin, creatinine
    actions: panel.cardiac, panel.inflammation, panel.renal, pericarditis_myocarditis
    advance: baseline workup documented
  6. 6BRANCHING_WORKUP
    CMR if myopericarditis suspected; pericardiocentesis with fluid analysis if large/tamponade or for TB / neoplastic; tuberculosis-targeted workup (ADA + AFB + IGRA + culture)
    inputs: cmr
    advance: syndrome subtype confirmed
  7. 7DIFFERENTIAL
    Pericarditis vs myopericarditis vs constrictive vs effusive-constrictive; etiology classification (ACC/AHA 2022)
    advance: classification documented
  8. 8RISK_STRATIFICATION
    High-risk features (fever >38, subacute, large effusion, tamponade, immunocompromised, AC, trauma, no NSAID response after 1 wk, troponin rise) → admit (ACC/AHA 2022)
    advance: admit / outpatient decision documented
  9. 9TREATMENT
    NSAID (high-dose ibuprofen or aspirin) tapered + colchicine 3–6 mo (Class IA, COPE/ICAP/CORP); recurrence → IL-1 blockade rilonacept (RHAPSODY) or anakinra (AIRTRIP); steroids only if refractory or contraindication (low dose 0.2–0.5 mg/kg); Dressler → colchicine + ASA; treat etiology
    inputs: creatinine
    advance: regimen + taper plan documented
  10. 10MONITORING
    CRP weekly until normal; symptom diary; monitor colchicine GI / renal; activity restriction (no competitive sports until inflammation resolves) (ACC/AHA 2022)
    actions: panel.inflammation
    advance: monitoring + activity guidance documented
  11. 11FOLLOWUP
    Recurrence prevention; cardiology referral for recurrent or constrictive evaluation (ACC/AHA 2022)
    advance: follow-up scheduled