What are the non-medical treatments for pericarditis?

Non-Medical Treatment for Pericarditis

The primary non-medical treatment for pericarditis is exercise restriction, which should be maintained until complete resolution of symptoms and normalization of inflammatory markers (CRP), ECG, and echocardiogram. 1

Exercise Restriction Guidelines

For Non-Athletes

• Restrict physical activity beyond ordinary sedentary life until symptoms resolve and CRP, ECG, and echocardiogram normalize 1
• This typically means avoiding any strenuous physical exertion while maintaining basic daily activities 1
• The restriction period is symptom-guided and continues until complete normalization of all parameters 1

For Athletes (Competitive Sports)

• Exercise restriction must be maintained for a minimum of 3 months from the initial onset of the attack 1
• Return to competitive sports is only permitted after symptoms have completely resolved AND diagnostic tests (CRP, ECG, echocardiogram) have normalized 1
• This longer restriction period for athletes is based on expert consensus due to documented cases of sudden cardiac death in military personnel and athletes after strenuous exertion 1

Special Considerations for Myopericarditis

Extended Restriction Period

• When myocardial involvement is present or suspected, physical exercise is contraindicated for at least 6 months from illness onset 1
• This applies to both athletes and non-athletes with myopericarditis 1
• Rest and avoidance of physical activity beyond normal sedentary activities is mandatory in all patients with myopericarditis 1

Rationale for Strict Restriction

• Sudden cardiac death cases have been reported in athletes without prodromic symptoms, including football (soccer) players and swimmers 1
• The risk is particularly elevated during the acute inflammatory phase when myocardial involvement is present 1

Clinical Pitfalls to Avoid

Premature Return to Activity

• Never allow return to exercise while CRP remains elevated or symptoms persist 1
• Inadequate rest during the acute phase may contribute to recurrence or complications 1
• The 3-month minimum for athletes is arbitrary but based on expert consensus to prevent catastrophic events 1

Monitoring Requirements

• Serial CRP measurements should guide the duration of activity restriction 1
• ECG and echocardiogram must be repeated to confirm normalization before clearance 1
• For athletes, consider more comprehensive cardiac evaluation before return to competitive sports 1

Practical Implementation

During Acute Phase

• Patients should maintain sedentary lifestyle, avoiding stairs, heavy lifting, or any activity causing dyspnea 1
• Hospitalization is recommended for patients with myocardial involvement to ensure adequate rest and monitoring 1

Gradual Return to Activity

• For non-athletes: gradual resumption of normal activities only after complete normalization of all parameters 1
• For athletes: structured return-to-play protocol after the mandatory 3-month period and complete resolution of inflammation 1

Documentation Requirements

• Document resolution of chest pain 1
• Confirm CRP normalization 1
• Verify normal ECG findings 1
• Confirm normal echocardiogram without effusion or wall motion abnormalities 1