From the Guidelines
Persistent tachycardia in pericarditis should be managed by treating the underlying inflammation with aspirin or NSAIDs as first-line therapy, along with colchicine as an adjunct, to reduce morbidity and mortality. The treatment approach should focus on alleviating the inflammatory process, as persistent tachycardia is a reflection of the body's response to pericardial inflammation. According to the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1, aspirin or NSAIDs are recommended as first-line therapy for acute pericarditis with gastroprotection, and colchicine is recommended as an adjunct to aspirin/NSAID therapy.
Key considerations in managing persistent tachycardia in pericarditis include:
- Using aspirin or NSAIDs as first-line therapy, with colchicine as an adjunct, to reduce inflammation and prevent recurrence
- Monitoring serum CRP to guide treatment length and assess response to therapy, as suggested by the guidelines 1
- Considering low-dose corticosteroids in cases of contraindication or failure of first-line therapy, but not as first-line therapy due to potential adverse effects
- Restricting exercise and physical activity until resolution of symptoms and normalization of CRP, ECG, and echocardiogram, as recommended by the guidelines 1
It is essential to monitor patients for complications such as cardiac tamponade or myocardial involvement and to adjust the treatment plan accordingly. If tachycardia persists despite adequate anti-inflammatory therapy, further evaluation for myopericarditis, pericardial effusion, or other cardiac complications is warranted. By prioritizing the treatment of underlying inflammation and monitoring for potential complications, healthcare providers can improve outcomes and reduce morbidity and mortality in patients with persistent tachycardia in pericarditis.
From the Research
Persistent Tachycardia in Pericarditis
- Persistent tachycardia is a symptom that can be associated with pericarditis, which is the inflammation of the pericardium, the membranous sac surrounding the heart 2.
- The treatment of pericarditis typically involves the use of non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and in some cases, corticosteroids 3, 2, 4, 5, 6.
- Colchicine has been shown to be effective in reducing the risk of recurrent pericarditis, and is often used in conjunction with NSAIDs 4, 6.
- The management of pericarditis should be individualized, with the goal of providing full daily control of symptoms and preventing recurrences 3.
Treatment Options
- NSAIDs are the mainstay of treatment for pericarditis, and are used to control pain and inflammation 3, 2, 4, 5.
- Colchicine is often used as an adjunctive therapy to NSAIDs, and has been shown to reduce the risk of recurrent pericarditis 4, 6.
- Corticosteroids may be used in cases where pericarditis does not respond to NSAIDs and colchicine, or in cases where there are specific medical conditions such as systemic autoimmune diseases or postpericardiotomy syndrome 3, 2.
- Interleukin-1 inhibitors, such as anakinra and rilonacept, may be used in cases of recurrent pericarditis that are refractory to conventional treatment 4, 5.
Recurrent Pericarditis
- Recurrent pericarditis is a common complication of acute pericarditis, and can occur in up to 30% of patients 2, 4, 5.
- The risk of recurrent pericarditis can be reduced with the use of colchicine and NSAIDs 4, 6.
- In cases of recurrent pericarditis, treatment should be tailored to the individual patient, and may involve the use of corticosteroids or interleukin-1 inhibitors 2, 4, 5.