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The risk stratification calculator for acute pericarditis evaluates the risk of complications by assessing specific clinical indicators provided by the user. The user selects from a predefined list of options related to symptoms and medical history, and the calculator determines if the individual's risk of complications is high.

The inputs are a set of indicators where each option is an indication of potential complications. Options include:

- Signs of cardiac tamponade
- Large pericardial effusion (diastolic echo-free space > 20 mm)
- History of chest trauma
- Oral anticoagulant therapy
- Associated myocarditis
- Immunosuppression
- Fever (> 38 degrees C)
- Subacute onset of symptoms
- No response to nonsteroidal anti-inflammatory drug therapy

Each input selected by the user corresponds to the above indicators and is evaluated to check whether any of these conditions are met. 

The computation is straightforward:
1. Each input is assessed to determine if it matches any of the specified indicators.
2. If any of the conditions (A to I) are true, the output is "Risk of complications is high."
3. If none of the conditions are true, the output is "Risk of complications is not high."
4. Additionally, if no selection is made, the output will prompt the user with "Please make a selection for all inputs."

The calculator in question is the Risk Stratification for Acute Pericarditis calculator. This tool is used in the clinical setting to assess the risk of complications in patients diagnosed with acute pericarditis. Acute pericarditis is an inflammation of the pericardium, the sac-like covering of the heart. 

The calculator is applicable to patients who have been diagnosed with acute pericarditis. It helps clinicians to stratify the risk of complications such as cardiac tamponade, constrictive pericarditis, or recurrence of pericarditis. This risk stratification can guide treatment decisions and follow-up planning.

The calculator uses several variables including age, cause of pericarditis, presence of myopericarditis, and response to NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) to calculate the risk score. 

Exclusion criteria for the use of this calculator would include patients who do not have a confirmed diagnosis of acute pericarditis, or those with contraindications to the medications used in the treatment of pericarditis.

Risk stratification for acute pericarditis

This diagnostic tool aims to evaluate the likelihood of acute pericarditis based on four key clinical criteria. Each criterion corresponds to common signs or findings associated with the condition:

- Characteristic symptoms of chest pain, described as sharp and pleuritic, which improve when the individual sits up and leans forward.
- Presence of a pericardial friction rub, identifiable as a scratchy or squeaking sound heard using a stethoscope over the left sternal border.
- Electrocardiogram (ECG) changes, specifically new diffuse ST segment elevation or PR depression during the acute phase.
- Detection of pericardial effusion via diagnostic imaging like an echocardiogram or computed tomography.

The tool operates on a simple logic: if any two or more of these criteria are met, acute pericarditis is considered likely. Specifically, the combinations it considers are:

- Characteristic chest pain and pericardial friction rub
- Characteristic chest pain and typical ECG changes
- Characteristic chest pain and pericardial effusion
- Pericardial friction rub and typical ECG changes
- Pericardial friction rub and pericardial effusion
- Typical ECG changes and pericardial effusion

The presence of two or more positive findings out of the four criteria signifies a high likelihood of acute pericarditis. Conversely, if fewer than two criteria are present, the condition is deemed unlikely. This decision-making process provides a structured approach to interpreting clinical evidence in diagnosing acute pericarditis, focusing on the correlation of symptoms, physical examination, and diagnostic findings.

The calculator in question is the Diagnostic Criteria for Acute Pericarditis. This clinical scoring system is used to diagnose acute pericarditis, a condition characterized by inflammation of the pericardium, the sac-like structure around the heart. 

The criteria are applicable to patients presenting with chest pain or other symptoms suggestive of pericardial disease. The clinical utility of this calculator is to aid in the diagnosis of acute pericarditis, which can help guide appropriate treatment and management strategies. 

The diagnostic criteria for acute pericarditis include: typical chest pain, pericardial friction rub, widespread ST elevation or PR depression on ECG, and new or worsening pericardial effusion. A diagnosis of acute pericarditis is made if at least two of these criteria are met.

There are no specific exclusion criteria for the use of this diagnostic criteria. However, it should be noted that these criteria may not be applicable in patients with other concurrent cardiac conditions that could mimic the symptoms or ECG changes of acute pericarditis. Therefore, clinical judgment should always be used in conjunction with these criteria.

Diagnostic criteria for acute pericarditis

The Torino Pericarditis Score calculator assesses the risk of developing complicated pericarditis based on five clinical indicators. Each indicator is assigned a specific numerical score, which are summed to produce a total score representing the risk level. The indicators and their respective scores are:

1. Female: 18 points
2. Fever > 38 degrees C: 20 points
3. Signs of constrictive pericarditis on echocardiography: 16 points
4. Previous use of corticosteroids: 21 points
5. Previous lack of colchicine use: 22 points

The calculator takes user inputs as boolean values (true or false) for each of the five clinical indicators. For each true response, the corresponding score is added to the total score. The computation involves summing the values from true responses only.

Based on the total score, the interpretation of the risk for complicated pericarditis is as follows:

- A score of 19 or less suggests a low risk.
- A score between 20 and 39 indicates an intermediate risk.
- A score of 40 or more signifies a high risk.

The output includes both the total score and its corresponding risk interpretation. For instance, if a patient is female (true), has a fever greater than 38 degrees C (true), and lacks previous colchicine use (true), the total score would be calculated as 18 + 20 + 22 = 60, indicating a high risk of complicated pericarditis.

The Torino Pericarditis Score is a clinical calculator used for predicting the risk of complicated pericarditis in patients diagnosed with acute pericarditis. Acute pericarditis is an inflammation of the pericardium, the sac-like structure around the heart. The Torino Pericarditis Score helps clinicians to stratify patients based on their risk of developing complications such as cardiac tamponade, constrictive pericarditis, or recurrence of pericarditis. 

This scoring system is applicable to patients with a confirmed diagnosis of acute pericarditis. It is not suitable for patients with chronic pericarditis, or those with pericarditis due to direct injury to the heart or pericardium, such as post-cardiac surgery or trauma. 

The Torino Pericarditis Score uses various clinical, laboratory, and imaging parameters to calculate the risk score. These include factors like fever, subacute onset, immunosuppression, trauma, oral anticoagulant therapy, myopericarditis, and pericardial effusion size. The higher the score, the higher the risk of developing complications. This score can guide clinicians in making decisions about hospitalization, intensive care, and aggressive therapeutic

Torino Pericarditis Score for prediction of complicated pericarditis

The calculator categorizes the severity of heart failure using the New York Heart Association (NYHA) functional classification system. It does this by analyzing a patient's reported physical abilities related to cardiac disease and matches them to one of the four NYHA classes.

Here's the breakdown of each class:

- Class I involves patients who have cardiac disease but do not experience any limitations in physical activity. Regular activities do not cause undue fatigue, palpitation, or shortness of breath.
  
- Class II fits patients who have a slight limitation in physical activity due to cardiac disease. They feel comfortable when at rest, but ordinary physical activities might lead to fatigue, palpitation, or breathlessness.
  
- Class III describes patients with a marked limitation in physical activity. These individuals are comfortable when resting, but even less than ordinary activities cause fatigue, palpitations, breathlessness, or chest pain.
  
- Class IV covers patients who cannot engage in any physical activity without experiencing discomfort. They exhibit symptoms of heart failure even when at rest, and any physical activity worsens these symptoms.

To determine the appropriate class for a patient, the calculator compares the user’s description of their physical ability with these four established patterns. Each condition is linked specifically to one of the NYHA classes, providing a clear pathway from symptom description to classification. For example, if a patient’s physical condition matches the criteria for Class I, then the result is "Class I." This comparison method efficiently identifies the level of heart failure severity based on self-reported abilities and symptoms.

The NYHA functional classification for heart failure, or New York Heart Association Functional Classification, is a scoring system used to quantify the severity of symptoms in patients with heart failure. This classification system is applicable to patients diagnosed with heart failure and is used to assess their functional capacity and limitations during physical activity. 

The NYHA classification is divided into four classes: Class I (no symptoms and no limitation in ordinary physical activity), Class II (mild symptoms and slight limitation during ordinary activity), Class III (marked limitation in activity due to symptoms, even during less-than-ordinary activity), and Class IV (severe limitations, experiences symptoms even while at rest).

The clinical utility of this calculator is to guide treatment decisions, assess prognosis, and evaluate the effectiveness of therapeutic interventions in patients with heart failure. It is also commonly used in clinical trials to stratify patients and measure outcomes. 

There are no specific exclusion criteria for its use, but it is subjective and relies on patient self-report, so it may not be as accurate in patients with cognitive impairment or communication difficulties.

Acute pericarditis

Background

Overview

Guidelines

Key sources