From the Guidelines
Pericarditis in teenagers is typically caused by viral infections and presents with sharp chest pain, and the mainstay of treatment is NSAIDs, such as ibuprofen or naproxen, with colchicine added to reduce recurrence risk. The symptoms of pericarditis in teenagers include sharp chest pain that worsens when lying down and improves when leaning forward, fever, and pleuropulmonary involvement 1. The causes of pericarditis in teenagers can be viral, bacterial, or idiopathic, with viral infections being the most common cause 1.
Diagnosis and Treatment
The diagnosis of pericarditis is based on clinical presentation, electrocardiogram (ECG), and echocardiogram findings 1. Treatment usually begins with NSAIDs like ibuprofen (600-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, followed by a gradual taper over 2-4 weeks 1. Colchicine (0.6mg once or twice daily depending on weight) is often added to reduce recurrence risk and should be continued for 3 months 1. Rest and avoiding strenuous physical activity for at least 3 months after diagnosis are crucial to prevent complications 1.
Prognosis and Quality of Life
Most cases in teenagers are viral and self-limiting, with complete recovery expected within weeks to months 1. However, teenagers should seek immediate medical attention if experiencing severe chest pain, shortness of breath, or fever, as these may indicate complications requiring hospitalization 1. Follow-up echocardiograms are typically recommended to monitor recovery and ensure there are no long-term cardiac effects 1. The long-term prognosis in children is good; however, quality of life can be severely affected with repeated recurrences, glucocorticoid dependence, and severe physical restriction 1.
Special Considerations
In children, including teenagers, corticosteroid use should be restricted due to the risk of side effects such as striae rubre and growth impairment 1. Anakinra (anti-IL-1 receptor) is a new option for children, especially if they are corticosteroid-dependent 1. The epidemiological background, such as the prevalence of tuberculosis, should also be considered when diagnosing and treating pericarditis in teenagers 1.
From the Research
Causes of Pericarditis in Teenagers
- The most common causes of acute pericarditis are idiopathic or viral, followed by pericarditis after cardiac procedures or operations 2
- In endemic areas, tuberculosis is the most common cause of pericarditis 2
- Other causes of pericarditis include autoimmune conditions, infection, chest trauma, cardiac surgery, or cardiac procedure 3
Symptoms of Pericarditis in Teenagers
- 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
- Retrosternal chest pain 3
- Diffuse upward sloping ST segments found with electrocardiogram 3
- Pericardial effusions may be demonstrated with an echocardiogram 3
Diagnosis and Treatment
- Acute pericarditis is diagnosed with presence of 2 or more of the following: sharp, pleuritic chest pain, new widespread electrocardiographic ST-segment elevation and PR depression, a new or increased pericardial effusion, or a pericardial friction rub 2
- 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, typically over several weeks 2
- Colchicine should be given for at least 3 months to relieve symptoms and reduce the risk of recurrence 2, 4