Pericarditis treatment: Difference between revisions
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==Management of Uncomplicated Pericarditis in the Absence of Significant Pericardial Effusion and Tamponade== | ==Management of Uncomplicated Pericarditis in the Absence of Significant Pericardial Effusion and Tamponade== | ||
Patients with uncomplicated acute pericarditis can generally be treated and followed up in an outpatient clinic. The treatment of viral or idiopathic pericarditis is with [[non-steroidal anti-inflammatory drug]]s. Patients should be observed for side effects since [[NSAID]]s are known to effect the GI mucosa. | Patients with uncomplicated acute pericarditis can generally be treated and followed up in an outpatient clinic. The treatment of viral or idiopathic pericarditis is with [[non-steroidal anti-inflammatory drug]]s. Patients should be observed for side effects since [[NSAID]]s are known to effect the GI mucosa. If the underlying cause of pericarditis is something other than a viral cause, the specific etiology should be treated. | ||
===Non-Steroidal Anti-inflammatory Drugs (NSAIDs)=== | |||
[[NSAIDs]] are the mainstay of therapy for uncomplicated pericarditis (viral or idiopathic pericarditis). The goal of therapy is to reduce pain and inflammation. While symptoms are improved by NSAIDs, the duration of the episode may not be reduced. The preferred NSAID is [[ibuprofen]] which has a large range of doses that can be titrated to the patient's tolerance.<!-- | |||
--><ref name="maisch2">{{cite journal | author= Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH | title= Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology | journal= Eur Heart J | year=2004 | pages=587–10 | volume=25 | issue=7 | pmid=15120056 | doi= 10.1016/j.ehj.2004.02.002}}</ref> Depending on the severity of symptoms, the dosing is between 300-800 mg every 6-8 hours for days or weeks as needed. In order to minimize a recurrence of symptoms, a slow tapering of the NSAID dose may be required. As with all NSAID use, GI prophylaxis should be strongly considered. | |||
===Aspirin Therapy=== | |||
An alternative therapy is [[aspirin]] 800 mg every 6-8 hours.<!-- | |||
--><ref name="imazio2">{{cite journal | author= Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R | title= Day-hospital treatment of acute pericarditis: a management program for outpatient therapy | journal= J Am Coll Cardiol | year=2004 | pages=1042–6 | volume=43 | issue=6 | pmid=15028364 | doi= 10.1016/j.jacc.2003.09.055}}</ref> | |||
===Post MI Pericarditis=== | |||
In pericarditis following [[acute myocardial infarction]], NSAIDs other than aspirin should be avoided since they can impair scar formation. | |||
===Failure to Respond to a Week of Traditional Therapy== | |||
Failure to respond to NSAIDs within one week (as indicated by persistence of [[fever]], a worsening of symptoms such as [[chest pain]], the development of a new [[pericardial effusion]]), likely indicates that the underlying cause may not be viral or idiopathic in nature. | |||
==Identification of High Risk or Complicated Pericarditis== | ==Identification of High Risk or Complicated Pericarditis== | ||
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* persistent symptomatic pericardial effusion | * persistent symptomatic pericardial effusion | ||
'''''[[Colchicine]]''''' can be used alone or in conjunction with NSAIDs in prevention of recurrent pericarditis and treatment of recurrent pericarditis. For patients with a first episode of acute idiopathic or viral pericarditis, they should be treated with an NSAID plus colchicine 2 mg on first day followed by 1 mg daily [http://circ.ahajournals.org/cgi/content/full/113/12/1622] for three months. <!-- | '''''[[Colchicine]]''''' can be used alone or in conjunction with NSAIDs in prevention of recurrent pericarditis and treatment of recurrent pericarditis. For patients with a first episode of acute idiopathic or viral pericarditis, they should be treated with an NSAID plus colchicine 2 mg on first day followed by 1 mg daily [http://circ.ahajournals.org/cgi/content/full/113/12/1622] for three months. <!-- | ||
Revision as of 13:20, 25 June 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
The management of pericarditis depends upon whether the patient has an uncomplicated or a complicated disease course.
Management of Uncomplicated Pericarditis in the Absence of Significant Pericardial Effusion and Tamponade
Patients with uncomplicated acute pericarditis can generally be treated and followed up in an outpatient clinic. The treatment of viral or idiopathic pericarditis is with non-steroidal anti-inflammatory drugs. Patients should be observed for side effects since NSAIDs are known to effect the GI mucosa. If the underlying cause of pericarditis is something other than a viral cause, the specific etiology should be treated.
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs are the mainstay of therapy for uncomplicated pericarditis (viral or idiopathic pericarditis). The goal of therapy is to reduce pain and inflammation. While symptoms are improved by NSAIDs, the duration of the episode may not be reduced. The preferred NSAID is ibuprofen which has a large range of doses that can be titrated to the patient's tolerance.[1] Depending on the severity of symptoms, the dosing is between 300-800 mg every 6-8 hours for days or weeks as needed. In order to minimize a recurrence of symptoms, a slow tapering of the NSAID dose may be required. As with all NSAID use, GI prophylaxis should be strongly considered.
Aspirin Therapy
An alternative therapy is aspirin 800 mg every 6-8 hours.[2]
Post MI Pericarditis
In pericarditis following acute myocardial infarction, NSAIDs other than aspirin should be avoided since they can impair scar formation.
=Failure to Respond to a Week of Traditional Therapy
Failure to respond to NSAIDs within one week (as indicated by persistence of fever, a worsening of symptoms such as chest pain, the development of a new pericardial effusion), likely indicates that the underlying cause may not be viral or idiopathic in nature.
Identification of High Risk or Complicated Pericarditis
Those with high risk factors for developing complications may required admission to an inpatient service for careful observation for hemodynamic compromise. High risk patients include:[2]
- subacute onset
- high fever (> 100.4 F) and leukocytosis
- development of cardiac tamponade
- large pericardial effusion (echo-free space > 20 mm) resistant to NSAID treatment
- immunocompromised
- history of oral anticoagulation therapy
- acute trauma
- failure to respond to seven days of NSAID treatment.
Severe cases of pericarditis may require:
Usual Steps in Treatment of Pericarditis
Pericardiocentesis is a procedure whereby the fluid in a pericardial effusion is removed through a needle. It is performed under the following conditions:[1]
- presence of moderate or severe cardiac tamponade
- diagnostic purpose for suspected purulent, tuberculosis, or neoplastic pericarditis
- persistent symptomatic pericardial effusion
Colchicine can be used alone or in conjunction with NSAIDs in prevention of recurrent pericarditis and treatment of recurrent pericarditis. For patients with a first episode of acute idiopathic or viral pericarditis, they should be treated with an NSAID plus colchicine 2 mg on first day followed by 1 mg daily [3] for three months. [3][4][5]
Corticosteroids are usually used in those cases that are clearly refractory to NSAIDs and colchicine and a specific cause has not been found. Systemic corticosteroids are usually reserved for those with autoimmune disease.
References
- ↑ 1.0 1.1 Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH (2004). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology". Eur Heart J. 25 (7): 587–10. doi:10.1016/j.ehj.2004.02.002. PMID 15120056.
- ↑ 2.0 2.1 Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R (2004). "Day-hospital treatment of acute pericarditis: a management program for outpatient therapy". J Am Coll Cardiol. 43 (6): 1042–6. doi:10.1016/j.jacc.2003.09.055. PMID 15028364.
- ↑ Adler Y, Zandman-Goddard G, Ravid M, Avidan B, Zemer D, Ehrenfeld M, Shemesh J, Tomer Y, Shoenfeld Y (1994). "Usefulness of colchicine in preventing recurrences of pericarditis". Am J of Cardiol. 73 (12): 916–7. doi:10.1016/0002-9149(94)90828-1. PMID 8184826.
- ↑ Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, Moratti M, Gaschino G, Giammaria M, Ghisio A, Belli R, Trinchero R (2005). "Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial". Circulation. 112 (13): 2012–6. doi:10.1161/CIRCULATIONAHA.105.542738. PMID 16186437.
- ↑ Imazio M, Bobbio M, Cecchi E, Demarie D, Pomari F, Moratti M, Ghisio A, Belli R, Trinchero R (2005). "Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (COlchicine for REcurrent pericarditis) trial". Arch Intern Med. 165 (17): 1987–91. doi:10.1001/archinte.165.17.1987. PMID 16186468.
de:Perikarditis nl:Pericarditis sv:Hjärtsäcksinflammation