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19 Evidence tables Evidence tables are available at the European Heart Journal online. 20 Data availability statement No new data were generated or analysed in support of this research. 21 Author information Author/Task Force Member Affiliations: Valentino Collini, Cardiology, Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy; Jan Gröschel, Charité —Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Berlin, Germany, and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany, and Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany; Yehuda Adler, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel; Antonio Brucato, Department of biomedical and clinical sciences, University of Milano, Fatebenefratelli Hospital, Milano, Italy; Vanessa Christian (United Kingdom), ESC Patient Forum, Sophia Antipolis, France; Vanessa M. Ferreira, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, Oxford, United Kingdom; Estelle Gandjbakhch, Cardiology Departement, Sorbonne Université, APHP, Hôpital Pitié Salpêtrière, Paris, France, and Referral Center for Inherited Cardiac Diseases, APHP, Hôpital Pitié Salpêtrière, Paris, France, and Inserm 1166, IHU ICAN, Paris, France; Bettina Heidecker, Deutsches Herzzentrum der Charité, Universitätsmedizin Berlin, Berlin, Germany, and Berlin Institute of Health (BIH), Charité, Universitätsmedizin Berlin, Berlin, Germany, and DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Mathieu Kerneis, Sorbonne Université, Paris, France, and ACTION Group, Paris, France, and UMRS 1166 Inserm, Paris, France, and Institute of Cardiology, Hôpital Pitié-Salpêtrière, Recommendations for post-cardiac injury syndrome Anti-inflammatory therapy is recommended in patients with PCIS to hasten symptom remission and reduce recurrences. I B IL-1 antagonists are recommended in patients with refractory PCIS to prevent recurrences and progression to constriction. I B High-dose aspirin is recommended as the first-choice anti-inflammatory therapy for post-myocardial infarction pericarditis and in patients already on antiplatelet therapy. I C Recommendations for purulent pericarditis Urgent pericardiocentesis and/or a surgical window is recommended in patients with suspicion of purulent pericarditis to establish a diagnosis. I C Recommendations for constrictive pericarditis Diagnosis Multimodality imaging is recommended in all patients with suspected constrictive pericarditis to make the diagnosis and assess pericardial thickening, calcifications, and active inflammation. I C Therapy Anti-inflammatory therapy is recommended in haemodynamically stable patients with a transient or new diagnosis of constriction with concomitant evidence of pericardial inflammation to prevent progression to constriction and avoid pericardiectomy. I C Pericardiectomy is recommended in patients with permanent constriction if there is no active inflammation or anti-inflammatory treatment is not successful after 3–6 months. I C Recommendations for pregnancy, lactation, and reproductive issues Pre-conception counselling is recommended in women with recurrent pericarditis or myocarditis to assess disease activity and to review therapy. I C Recommendations for physical activity and myocarditis/pericarditis Restriction of physical exercise until remission, for at least 1 month, is recommended in athletes and non-athletes after IMPS using an individualized approach to accelerate recovery. I C Recommendations for multidisciplinary teams in myopericardial syndromes A multidisciplinary team discussion at a referral centre is recommended in patients with high-risk/complicated IMPS to provide a patient-tailored approach. I C © ESC 2025 AVB, atrioventricular block; CA, cardiac arrest; CMR, cardiovascular magnetic resonance; CS, cardiac sarcoidosis; CT, computed tomography; DNA, deoxyribonucleic acid; ECG, electrocardiogram; EMB, endomyocardial biopsy; ESC, European Society of Cardiology; 18F-FDG-PET, [18F]-fluorodeoxyglucose positron emission tomography; GCM, giant-cell myocarditis; HF, heart failure; HIV, human immunodeficiency virus; ICD, implantable cardioverter-defibrillator; ICI, immune checkpoint inhibitor; IL, interleukin; IMPS; inflammatory myopericardial syndrome; LGE, late gadolinium enhancement; LV, left ventricle; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; NSAID, non-steroidal anti-inflammatory drug; PCIS, post-cardiac injury syndrome; SCD; sudden cardiac death; VF, ventricular fibrillation; VT, ventricular tachycardia. aClass of recommendation. bLevel of evidence. ESC Guidelines 4023 Downloaded from academic.oup.com/eurheartj/article/46/40/3952/8234483 by guest on 07 October 2026