What are the signs and symptoms (s/s) of pericarditis?

From the Guidelines

Pericarditis should be managed with nonsteroidal anti-inflammatory medications for 2 to 4 weeks and 3 months of colchicine, while avoiding steroids to reduce the risk of recurrent pericarditis, as recommended by the most recent guidelines 1. The diagnosis of pericarditis is based on clinical presentation, electrocardiographic findings, and echocardiography results.

• Clinical manifestations of pericarditis include chest pain that is sharp, pleuritic, and which may be improved by sitting up or leaning forward.
• A pericardial friction rub may be audible.
• Widespread ST-elevation with PR depression is the electrocardiographic hallmark, although changes are nonspecific and may be transient. The treatment approach may vary depending on the underlying cause and severity of the disease.
• For patients with acute pericarditis, hospitalization is warranted to determine the etiology and observe for tamponade as well as the effect of treatment.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin are the mainstay of treatment, with colchicine added to reduce the risk of recurrence.
• Systemic corticosteroid therapy should be restricted to connective tissue diseases, autoreactive or uremic pericarditis. It is essential to monitor patients for cardiac tamponade, a life-threatening complication requiring immediate pericardiocentesis, and to perform regular echocardiography to monitor pericardial effusion and cardiac function during treatment, as recommended by recent guidelines 1.
• Competitive athletes with acute pericarditis should not participate in competitive sports because of the increased risk of exacerbating an inflammatory response.
• Athletes who have recovered from pericarditis should resume competitive sports participation in a gradual fashion with longitudinal monitoring for symptoms of recurrent pericarditis.

From the Research

Treatment of Pericarditis

• The treatment of pericarditis typically involves empiric anti-inflammatory therapy, with aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) being the mainstay of therapy 2.
• Colchicine is often used as an adjunct to NSAIDs, especially for recurrences, and has been shown to be effective in reducing the number of pericarditis recurrences in patients with recurrent pericarditis or acute pericarditis 3, 4, 5.
• Corticosteroids are a second choice for difficult cases requiring multi-drug therapies and specific medical conditions, such as systemic autoimmune diseases, postpericardiotomy syndrome, and pregnancy 2.

Colchicine Therapy

• Colchicine has been suggested to be beneficial in preventing recurrent pericarditis, with moderate quality evidence showing that it reduces episodes of pericarditis in people with recurrent pericarditis over 18 months follow-up 3.
• The recommended dose of colchicine is 0.5mg twice daily for patients >70kg or once daily for those weighing less, in addition to standard anti-inflammatory therapy 4.
• Colchicine monotherapy has been compared to NSAID monotherapy or combination therapy for the prevention of recurrent pericarditis in patients with heart failure with reduced ejection fraction and/or coronary artery disease, with no difference in the primary outcome observed between groups 6.

Adverse Effects

• The most common side effect of colchicine is gastrointestinal intolerance, occurring in 5-10% of cases, which may be controlled by dose reduction or temporary discontinuation 4.
• Adverse effects of colchicine are mainly gastrointestinal and include abdominal pain and diarrhea, with a pooled risk ratio of 1.26 for adverse events 3.
• The quality of evidence for adverse effects is low due to imprecision, and there is no statistically significant difference between the treatment groups 3.