Acute myopericardial syndromes are common but can be challenging to manage and potentially have life-threatening complications. Careful clinical history, physical examination, electrocardiogram interpretation, and application of diagnostic criteria are needed to make an accurate diagnosis, exclude concomitant disease, and properly treat patients. Therapy for acute pericarditis should be guided per the underlying cause. For the most common causes, nonsteroidal antiinflammatory drugs or aspirin with the addition of colchicine remains the mainstay of therapy. Patients with hemodynamic compromise who are resistant to therapy or display high-risk features should prompt hospitalization and initiation of more aggressive and/or invasive therapy.