Acute pericarditis (AP) is the second most common cardiac cause of chest pain, diagnosed when at least two of the following criteria are met: characteristic pleuritic chest pain, pericardial rub on auscultation, new typical ECG changes (such as widespread ST-elevation or PR-depression) and pericardial effusion on imaging.1 Supporting evidence of elevated inflammatory biomarkers and findings of pericardial inflammation on cardiac magnetic resonance or CT also play critical roles in its evaluation. There is currently renewed interest in pericardial diseases because of contemporary advances in multimodality imaging to diagnose, risk stratify and monitor these conditions and targeted therapies such as anti-interleukin-1 agents to more effectively treat recurrent pericarditis.2 3 Despite being frequently encountered clinically, there remain many knowledge gaps with regards to the natural history, pathophysiology, clinical features and management strategies for AP, and paucity of literature regarding age-specific characteristics of AP especially in the very elderly and young patients.

Collini et al performed a retrospective cohort study of 471 first-time AP patients divided into four age-groups (18–35, 35–55, 55–75 and >75 years), and had several interesting findings.4 First, younger patients were more likely to be male, to present with characteristic pericarditis features including chest pain, pericardial rubs on auscultation and widespread ST elevation on ECG, but were less likely to have shortness of breath and pericardial effusion, compared …