Assess for typical symptoms: sharp pleuritic chest pain, worse when lying flat, improved by sitting up and leaning forward
Check for associated symptoms: fever, dyspnea, palpitations, recent viral illness, autoimmune disease, kidney failure, recent MI, trauma, or cancer
Perform physical examination for a pericardial friction rub
Obtain a 12-lead ECG for diffuse ST-segment elevation and PR-segment depression
Order blood tests for inflammatory markers such as CRP and ESR
Check cardiac troponin to assess for associated myocarditis
Obtain transthoracic echocardiography to look for pericardial effusion and signs of tamponade
Consider chest X-ray to assess heart size and alternative causes of chest pain
Use cardiac CT or cardiac MRI if the diagnosis is unclear or to evaluate pericardial inflammation
Evaluate for underlying causes with targeted testing based on clinical context
Diagnose acute pericarditis when at least two of the following are present: typical chest pain, pericardial rub, ECG changes, or pericardial effusion