Symptoms typically occur with an ongoing or preceding upper respiratory infection. Exertion may exacerbate chest pain, but the pleuritic nature and positional component persist. When pericarditis follows myocardial infarction, ischemic chest pain precedes. Coexistent symptoms of pneumonitis suggest a bacterial etiology, especially with high fever. Recurrent fevers, sweats, and weight loss suggest tuberculosis.
Malignant pericarditis is usually metastatic with other clinical evidence of malignancy.
Common primary tumors include lung, breast, melanoma, lymphoma, and leukemia. Physical examination includes a careful assessment of vital signs with determination of pulsus paradoxicus. Neck vein distension, distant heart tones, and poor peripheral perfusion suggest cardiac tamponade, especially with a pulsus paradoxicus of greater than 10 mm Hg. Lung auscultation may show signs of consolidation. Cardiac auscultation provides the important, but often evanescent, pericardial friction rub, which may be of one, two, or three components.