From the Guidelines
Pericarditis should be treated with aspirin or NSAIDs as the mainstay of therapy, with colchicine added to improve response and prevent recurrences, as recommended by the 2015 ESC guidelines 1. The symptoms of pericarditis include sharp chest pain that worsens when lying down or breathing deeply and improves when sitting up and leaning forward, fever, weakness, cough, and heart palpitations.
Diagnosis and Treatment
- Diagnosis typically involves ECG findings, which often show widespread ST-segment elevation.
- Treatment primarily focuses on reducing inflammation with medications.
- First-line therapy includes NSAIDs such as ibuprofen (600-800mg three times daily) or aspirin (650-1000mg every 4-6 hours) for 1-2 weeks, followed by a gradual taper over 2-4 weeks.
- Colchicine (0.5mg twice daily for patients >70kg or 0.5mg once daily for patients <70kg) is often added to NSAIDs for 3 months to improve response and prevent recurrence, as supported by the European Society of Cardiology guidelines 1.
Recurrent Pericarditis
- For severe or recurrent cases, corticosteroids like prednisone may be used, starting at 0.25-0.5mg/kg daily with a slow taper, but should be avoided if infections, particularly bacterial and TB, cannot be excluded 1.
- Rest and avoiding strenuous physical activity are recommended until symptoms resolve.
Prognosis
- Most cases of pericarditis improve within weeks with proper treatment, though recurrence occurs in about 15-30% of patients.
- The condition results from the body's inflammatory response, which can be triggered by viral infections, autoimmune disorders, heart attacks, or trauma to the chest.
Risk Factors
- High fever, subacute course, evidence of large pericardial effusion, cardiac tamponade, and failure to respond to NSAIDs are associated with an increased risk of complications 1.
- Other risk factors include pericarditis associated with myocarditis, immunodepression, trauma, and oral anticoagulant therapy.
From the Research
Symptoms of Pericarditis
- Sharp, pleuritic chest pain that worsens when supine (≈90%) 2
- New widespread electrocardiographic ST-segment elevation and PR depression (≈25%-50%) 2
- A new or increased pericardial effusion that is most often small (≈60%) 2
- Pericardial friction rub (<30%) 2
- Fever and typical chest pain increasing on inspiration and radiating to the trapezius ridge in tamponade caused by acute pericarditis 3
- Dyspnoea, orthopnoea, weakness, fatigue, tachycardia, and oliguria in cardiac tamponade 3
Treatment of Pericarditis
- High-dose nonsteroidal anti-inflammatory drugs (NSAIDs) for acute idiopathic and pericarditis after cardiac procedures or operations 2, 4, 5
- Colchicine to relieve symptoms and reduce the risk of recurrence, with a 3-month course for the first episode and at least 6 months for recurrences 2, 5
- Corticosteroids for patients who do not improve with NSAIDs and colchicine, or for those with multiple recurrences 2, 4, 5
- Interleukin 1 (IL-1) blockers for selected patients with multiple recurrences as steroid-sparing therapy 2, 5
- Antituberculosis therapy for pericarditis caused by tuberculosis 2
- Echocardiography-guided pericardiocentesis for cardiac tamponade, with surgical management indicated in certain cases 3