From the Guidelines
Pericarditis should be diagnosed and treated with a combination of clinical presentation, electrocardiogram (ECG) findings, laboratory tests, and imaging studies, and first-line therapy should include aspirin/NSAIDs and colchicine (0.5 mg twice or once daily for patients < 70 kg or intolerant to higher doses) for 3 months, as recommended by the 2015 ESC guidelines 1. The diagnosis of pericarditis requires at least two of the following: characteristic chest pain, pericardial friction rub on examination, typical ECG changes (widespread ST elevation and PR depression), or evidence of pericardial effusion on imaging.
- Key diagnostic features include:
- Sharp, pleuritic chest pain that improves with sitting forward and worsens with lying flat
- Pericardial friction rub on examination
- Typical ECG changes
- Evidence of pericardial effusion on imaging
- Elevated inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) Treatment focuses on reducing inflammation and managing pain, with colchicine use recommended as first-line therapy for acute pericarditis as an adjunct to aspirin/NSAIDs therapy (3 months) and also recommended for recurrent pericarditis (6 months) 1.
- Key treatment features include:
- Aspirin/NSAIDs therapy
- Colchicine (0.5 mg twice or once daily for patients < 70 kg or intolerant to higher doses)
- CRP should be considered to guide the treatment duration and assess the response to therapy 1
- Corticosteroids are not recommended as first-line therapy for acute pericarditis, but may be used in refractory cases or recurrent pericarditis 1 Hospital admission is recommended for high-risk patients with acute pericarditis, and patients should be monitored for complications such as cardiac tamponade or constrictive pericarditis, which may require additional interventions including pericardiocentesis or pericardiectomy in severe cases 1.
From the Research
Diagnosis of Pericarditis
- Pericarditis is diagnosed with the presence of 2 or more of the following: sharp, pleuritic chest pain that worsens when supine, new widespread electrocardiographic ST-segment elevation and PR depression, a new or increased pericardial effusion, or a pericardial friction rub 2
- The most common causes of acute pericarditis are idiopathic or viral, followed by pericarditis after cardiac procedures or operations 2
Treatment Options for Pericarditis
- Treatment of acute idiopathic and pericarditis after cardiac procedures or operations involves use of high-dose nonsteroidal anti-inflammatory drugs (NSAIDs), with doses tapered once chest pain has resolved and C-reactive protein level has normalized 2
- Colchicine is often used in conjunction with NSAIDs to relieve symptoms and reduce the risk of recurrence 3, 2, 4
- Corticosteroids are often used if pericarditis does not improve with NSAIDs and colchicine 3, 5, 2
- Immunosuppressive agents, such as azathioprine, methotrexate, and mycophenolate mofetyl, may be used in patients with recurrent pericarditis unresponsive to corticosteroids 6
- Interleukin 1 (IL-1) blockers have demonstrated efficacy in patients with multiple recurrences and may be preferred to corticosteroids 2, 4
Recurrence Prevention
- Colchicine has been shown to be effective in reducing the risk of recurrent pericarditis 4
- Anti-interleukin-1 agents, such as anakinra and rilonacept, have also been shown to be effective in reducing recurrences 4
- A 3-month course of colchicine is recommended to relieve symptoms and reduce the risk of recurrence, and should be continued for at least 6 months with a first recurrence of pericarditis 2