What is the treatment for post-Coronary Artery Bypass Grafting (CABG) chest pain and dyspnea with a high-pitched squeak over the left sternal border, suggestive of pericarditis?

From the Guidelines

The treatment for post-CABG chest pain and dyspnea with a high-pitched squeak over the left sternal border suggestive of pericarditis typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, with ibuprofen being the agent of choice, as recommended by the European Society of Cardiology 1. The use of NSAIDs, such as ibuprofen, is supported by the European Society of Cardiology guidelines, which suggest that ibuprofen increases coronary flow and is the agent of choice for the treatment of pericarditis 1.

• The recommended dose of ibuprofen is 600-800 mg three times daily for 1-2 weeks, followed by a gradual taper over 2-4 weeks.
• Aspirin 650-1000 mg three to four times daily for 1-2 weeks can also be used as an alternative to ibuprofen.
• Colchicine should be added at 0.5-0.6 mg twice daily for 3 months to improve outcomes and prevent recurrence.
• For patients with contraindications to NSAIDs, such as recent cardiac surgery with concern for bleeding, prednisone 0.25-0.5 mg/kg/day may be used, though it should be avoided if possible as it may increase recurrence risk.
• Pain control with acetaminophen or, if necessary, opioids may be needed.
• Patients should be monitored for symptom improvement within 1-2 weeks and require follow-up echocardiography to assess for pericardial effusion or constriction.
• Activity restriction is advised during the acute phase, with gradual return to normal activities as symptoms resolve. It is essential to note that the treatment of pericarditis should prioritize the reduction of inflammation and the prevention of complications, such as tamponade or constrictive pericarditis, as highlighted by the European Society of Cardiology guidelines 1.

From the FDA Drug Label

NSAIDs are contraindicated in the setting of CABG surgery Avoid taking NSAIDs after a recent heart attack, unless your healthcare provider tells you to. Ibuprofen Tablets are contraindicated in the setting of coronary artery bypass graft (CABG) surgery

The treatment for post-Coronary Artery Bypass Grafting (CABG) chest pain and dyspnea with a high-pitched squeak over the left sternal border, suggestive of pericarditis, is not explicitly stated in the provided drug labels. However, considering the contraindication of NSAIDs in the setting of CABG surgery, it is likely that alternative treatments should be considered. Colchicine or aspirin may be used to treat pericarditis, but this information is not present in the provided labels. Therefore, the best course of action would be to consult a healthcare provider for proper diagnosis and treatment. 2, 2, 2

From the Research

Treatment for Post-CABG Chest Pain and Dyspnea

The treatment for post-Coronary Artery Bypass Grafting (CABG) chest pain and dyspnea with a high-pitched squeak over the left sternal border, suggestive of pericarditis, involves several options:

• Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) as the mainstay of therapy 3
• Colchicine as an adjunct to aspirin or NSAIDs, especially for recurrences 3, 4, 5
• Corticosteroids as a second choice for difficult cases requiring multi-drug therapies and specific medical conditions 3, 6
• Immunosuppressive agents, such as azathioprine, methotrexate, and mycophenolate mofetyl, for patients with idiopathic recurrent pericarditis unresponsive to corticosteroids or with unacceptable side effects 7

Specific Considerations

• Pericardial drainage may be necessary for patients with significant effusion after CABG to prevent subsequent constrictive pericarditis 6
• Colchicine may be efficacious for the prevention of postpericardiotomy syndrome in patients after cardiac surgery 5
• Treatment should be individualized, providing the attack dose every 8 hours to ensure full daily control of symptoms and till remission and C-reactive protein normalization, and then tapering should be considered 3

Medication Options

• Aspirin: 500-1000 mg every 8 hours 3
• NSAIDs: e.g., ibuprofen 400-800 mg every 8 hours 3
• Colchicine: 0.5-1.5 mg daily 4, 5
• Corticosteroids: e.g., prednisone 20-50 mg daily 3, 6
• Immunosuppressive agents: e.g., azathioprine 50-100 mg daily, methotrexate 5-10 mg weekly, mycophenolate mofetyl 500-1000 mg daily 7