Cardiac Consult: A Cleveland Clinic Podcast for Healthcare Professionals American College of Cardiology Concise Clinical Guidance on Pericarditis
Nov 26, 2025
Allan Klein, MD, an expert in pericardial disease diagnosis, and Tom Kai Ming Wang, MBChB, a specialist in cardiovascular imaging, delve into the 2025 ACC guidelines on pericarditis. They discuss innovative diagnostic criteria using multimodality imaging and the emerging role of IL-1 blockers for recurrent cases. Practical strategies for optimizing patient outcomes and appropriately identifying treatment options are highlighted, alongside insights into surgical choices and the latest clinical trials exploring new therapies in this evolving field.
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New Definition Increases Diagnostic Accuracy
- The ACC defines pericarditis using symptom, imaging, and inflammatory markers with equal weight to improve accuracy.
- Cases are categorized as definite, possible, or unlikely to optimize diagnosis and reduce mis/under-diagnosis.
CMR Guides Diagnosis And Severity Grading
- Multimodality imaging places CMR central for diagnosis, grading, and guiding therapy when echo is unrevealing.
- A five-point CMR LGE grading (none→severe) helps risk stratify patients and predict disease course.
Start With Echo, Escalate To Pericardial CMR
- Use transthoracic echo first to assess effusion, thickening, and constrictive physiology at the bedside.
- If echo is normal but suspicion persists, obtain a pericardial-specific CMR with LGE and T2 edema sequences.