Pericarditis treatment: Difference between revisions
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* Failure to respond to seven days of NSAID treatment | * Failure to respond to seven days of NSAID treatment | ||
The | ==The Management of Complicated Pericarditis Including Patients with Cardiac Tamponade and Large Pericardial Effusions== | ||
* [[Pericardiocentesis]] to relieve a large effusion or treat [[cardiac tamponade]] | |||
* [[Antibiotic]]s to manage an underlying infection | See also: [[Cardiac tamponade]], [[Pericardial effusions]], [[Constrictive pericarditis]], [[Pericardiocentesis]] | ||
* [[Steroid]]s in recurrent refractory cases or in patients with autoimmune disease | |||
* [[Colchicine]] in patients with recurrent or refractory disease | * [[Pericardiocentesis]] may be required to relieve a large effusion or treat [[cardiac tamponade]] | ||
* [[Antibiotic]]s may be required to manage an underlying infection or to manage purulent pericarditis | |||
* [[Steroid]]s may be required in recurrent refractory cases or in patients with autoimmune disease | |||
* [[Colchicine]] may be required in patients with recurrent or refractory disease (see below) | |||
* [[Surgery]] in the presence of recurrent effusion or [[constrictive pericarditis]] | * [[Surgery]] in the presence of recurrent effusion or [[constrictive pericarditis]] | ||
Revision as of 14:07, 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. These patients may require re-evaluation, observation and more aggressive therapy as described in the next section.
Identification of High Risk or Complicated Pericarditis
Patients at high risk of developing complications of pericarditis may required admission to an inpatient service for careful observation for hemodynamic compromise. High risk patients include those with:[2]
- Acute 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 status
- History of oral anticoagulation therapy
- Pericarditis secondary to acute trauma
- Failure to respond to seven days of NSAID treatment
The Management of Complicated Pericarditis Including Patients with Cardiac Tamponade and Large Pericardial Effusions
See also: Cardiac tamponade, Pericardial effusions, Constrictive pericarditis, Pericardiocentesis
- Pericardiocentesis may be required to relieve a large effusion or treat cardiac tamponade
- Antibiotics may be required to manage an underlying infection or to manage purulent pericarditis
- Steroids may be required in recurrent refractory cases or in patients with autoimmune disease
- Colchicine may be required in patients with recurrent or refractory disease (see below)
- Surgery in the presence of recurrent effusion or constrictive pericarditis
Management of Cardiac Tamponade and Large Pericardial Effusions
Pericardiocentesis is a procedure whereby the fluid in a pericardial effusion is removed through a needle. It is performed under the following conditions:[1]
- resence of moderate or severe cardiac tamponade
- diagnostic purpose for suspected purulent, tuberculosis, or neoplastic pericarditis
- persistent symptomatic pericardial effusion
Management of Recurrent Pericarditis
Colchicine can be used alone or in conjunction with NSAIDs in prevention of recurrent pericarditis and treatment of recurrent pericarditis. Treatment involves a 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.
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