This patient should receive clinical follow-up without hospital admission or further diagnostic testing to monitor her response to therapy, evaluate for possible complications, and assess the timing for tapering her medications. Slow tapering over 2 to 4 weeks after initial presentation with improvement in symptoms is usually performed to reduce the risk of recurrent inflammation.

The vast majority of patients with acute pericarditis, including the patient presented, can be managed medically on an outpatient basis. For a subset of patients, high-risk features of acute pericarditis may be present and warrant hospitalization for treatment and monitoring for possible complications; these include fever, leukocytosis, acute trauma, abnormal cardiac biomarkers, an immunocompromised host, oral anticoagulant use, large pericardial effusions, or evidence of cardiac tamponade.

CT can be used to show pericardial thickening in patients with acute pericarditis. However, this finding would not change the diagnosis or appropriate management strategy in this patient.

Medical therapy with anti-inflammatory agents is appropriate for acute pericarditis. However, glucocorticoids are reserved for patients who do not respond to NSAIDs, such as ibuprofen, aspirin, and indomethacin, none of which has been tried yet in this patient. Glucocorticoid therapy may also increase the risk of recurrent pericarditis and should only be considered in highly selected patients with refractory pericarditis.

Pericardiocentesis is indicated only for patients with tamponade or for those in whom the analysis of pericardial fluid can be of assistance in diagnosis and management. Signs of tamponade are not present in this patient whose inferior vena cava is normal in size on echocardiography, whose Doppler ultrasound shows minimal change in mitral inflow with respiration, and whose bedside maneuvers reveal no pulsus paradoxus.