Materiały źródłowe

• #1 Pericarditis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pericarditis/diagnosis-treatment/drc-20352514

  Treatment for pericarditis depends on the cause of the symptoms and how serious they are. Mild pericarditis may get better without treatment. […] Medicines often are used to treat symptoms of pericarditis. Examples include: […] Pain relievers. Pericarditis pain often can be treated using pain relievers sold without a prescription. These include aspirin and ibuprofen (Advil, Motrin IB, others). […] Colchicine (Colcrys, Mitigare, others). This medicine lowers inflammation in the body. It’s used to treat sudden pericarditis or if symptoms tend to come back. […] Corticosteroids. Corticosteroids are strong medicines that fight inflammation. A corticosteroid such as prednisone may be given if pericarditis symptoms don’t get better with other medicines. […] Immunosuppressants. These medicines turn down the immune system to lower the inflammation it makes.

• #2 Pericarditis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pericarditis/symptoms-causes/syc-20352510

  Pericarditis often is mild. It may go away without treatment. Treatment for more-serious symptoms can include medicines and, very rarely, surgery. […] When healthcare professionals find and treat pericarditis early, that may help lower the risk of long-term complications from pericarditis. […] When pericarditis is found and treated early, the risk of complications usually becomes lower.

• #3 Management of acute pericarditis: treatment and follow-up

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Management-of-acute-pericarditis-treatment-and-follow-up

  Acute pericarditis is a self-limiting disease without significant complications or recurrences in 70% to 90% of patients. If the laboratory data support the clinical diagnosis, symptomatic treatment with aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) with gastroprotection should be initiated. Colchicine is recommended first-line therapy as an adjunct to aspirin/NSAIDs. Low-dose corticosteroids should be considered in cases of contraindications/failure of aspirin/NSAIDs and colchicine, and when an infectious cause has been excluded, or when there is a specific indication such as autoimmune disease. Serum CRP guides the treatment length and response to therapy. […] Aspirin or NSAIDs are mainstays of therapy for acute pericarditis. If laboratory data support the clinical diagnosis, symptomatic treatment with NSAIDs should be initiated. Because of its excellent safety, the preferred NSAIDs is ibuprofen in a dose of 600 to 800 mg orally, three times daily with discontinuation if pain is no longer present after two weeks. Many patients have very gratifying responses to the first or second dose of NSAIDs, and most respond fully with no need for additional treatment. The choice of drug should be based on the medical history of the patient, including contraindications, previous efficacy or side effects, the presence of concomitant diseases favouring aspirin over other NSAIDs when aspirin is already needed as an antiplatelet treatment, and finally the physician’s expert skills and knowledge.

• #4 Acute Pericarditis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p553.html

  Acute pericarditis is the most common affliction of the pericardium. […] First-line treatment includes nonsteroidal anti-inflammatory drugs and colchicine. […] Patients with acute pericarditis should be treated empirically with nonsteroidal anti-inflammatory drugs. […] Colchicine is used to treat recurrent pericarditis or pericarditis that does not respond to conventional treatment. […] In general, glucocorticoids should not be used as first-line therapy for patients with acute pericarditis. […] Glucocorticoids may be considered when the cause of the acute pericarditis is connective tissue disease, autoreactivity, or uremia.

• #5 Acute Pericarditis

  https://www.uspharmacist.com/article/acute-pericarditis

  Most viral and idiopathic cases of pericarditis are self-limiting. Management should focus on both symptom relief and treatment of the underlying disease. Most cases of acute pericarditis can be managed on an outpatient basis. If a pericardial effusion is suspected, or if the patient presents with hemodynamic instability, hospital admission may be warranted to better diagnose and manage any complications that may arise. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are the drugs of choice for treating pericarditis, based on European Society of Cardiology (ESC) guidelines published in 2004. Historically, indomethacin (25-50 mg 3 times/day) has been commonly prescribed; however, it carries an unfavorable adverse-reaction (AR) profile and a propensity for reducing coronary blood flow compared with ibuprofen (300-800 mg 3-4 times/day). Aspirin (325-650 mg 3 times/day) may be used if the patient has suffered a recent (7-10 days) MI, in which case other NSAIDs are contraindicated. Overall, the NSAIDs have similar efficacy, with chest-pain relief seen within days in approximately 85% to 90% of patients. Treatment should be continued until the patient is asymptomatic and/or afebrile for several days; the dose may be gradually tapered. Parenteral ketorolac tromethamine may also be used for more immediate relief of symptoms in hospitalized patients, but there is a higher risk of gastrointestinal (GI) bleeds in patients who are elderly, have renal insufficiency, or have low body weight.

• #6 Acute Pericarditis Treatment & Management: Approach Considerations, Prehospital Care, Emergency Department Care

  https://emedicine.medscape.com/article/156951-treatment

  The 2015 ESC updated guidelines have the following recommendations for patients with PCIS: Administer anti-inflammatory therapy to speed up symptomatic remission and reduce recurrences (class I, level B evidence). […] Aspirin is first line for anti-inflammatory therapy of post-myocardial infarction (MI) pericarditis, as well as for individuals receiving antiplatelet therapy (class I, level C evidence). […] Consider adding colchicine to aspirin/NSAIDs to treat PCIS, as for treating acute pericarditis (class IIa, level B evidence). […] The 2015 ESC guidelines recommend pericardiocentesis for treating cardiac tamponade and large chronic effusions resistant to dialysis. […] Early intervention with dialysis may prevent the development of uremic pericarditis.

• #6 Acute Pericarditis Treatment & Management: Approach Considerations, Prehospital Care, Emergency Department Care

  https://emedicine.medscape.com/article/156951-treatment

  Administer intravenous antibiotics (class I). […] Consider subxiphoid pericardiotomy and pericardial cavity rinsing (class IIa). […] Consider intrapericardial thrombolysis (class IIa). […] Consider pericardial aspiration and/or drainage in the setting of nonresponse to dialysis (class IIb). […] The treatment for specific types of pericarditis are briefly discussed in this section. […] Treatment for this condition is similar to viral pericarditis and includes anti-inflammatory drugs to control symptoms and inflammation. […] The treatment of viral pericarditis is based on the symptoms present, with observation for the development of tamponade. Treatment for bacterial pericarditis includes appropriate antibiotics for at least 4 weeks and drainage of pericardial fluid. […] The 2015 ESC updated guidelines recommend consideration of intrapericardial urokinase to reduce the risk of constriction in tuberculous effusive pericarditis (class IIb, level C evidence).

• #6 Acute Pericarditis Treatment & Management: Approach Considerations, Prehospital Care, Emergency Department Care

  https://emedicine.medscape.com/article/156951-treatment

  Perform urgent pericardiocentesis or cardiac surgery for cardiac tamponade or for symptomatic moderate to large pericardial effusions refractory to medical therapy, as well as when an unknown bacterial or neoplastic etiology is suspected (class I). […] Pericardiectomy is the treatment mainstay of chronic permanent constriction (class I). To prevent progression of constriction, administer medical therapy for specific pericarditis conditions (ie, tuberculous pericarditis) (class I). […] Consider empiric anti-inflammatory therapy in the setting of transient or new diagnosis of constriction with concomitant evidence of pericardial inflammation (ie, elevated CRP or pericardial enhancement on computed tomography scan/cardiac magnetic resonance imaging) (class IIb). […] Perform effective pericardial drainage (class I).

• #6 Acute Pericarditis Treatment & Management: Approach Considerations, Prehospital Care, Emergency Department Care

  https://emedicine.medscape.com/article/156951-treatment

  Oxygen and a cardiac monitor should be provided. Rule out other life-threatening causes of chest pain, such as myocardial infarction (MI) or aortic dissection. Evaluate for evidence of hemodynamic instability. Consider whether further management is safe to continue on an outpatient basis. […] The 2015 European Society of Cardiology (ESC) update of their 2004 guidelines on the diagnosis and management of pericardial diseases recommends managing patients considered to be low risk (no risk factors) on an outpatient basis, whereas those with at least one risk factor should be managed as inpatients (both class I, level B evidence). […] After 1 week, evaluate the clinical response to anti-inflammatory therapy (class I, level B evidence). […] In patients with pericardial effusion, treat the underlying cause. In the setting of pericardial effusion and systemic inflammation, administer aspirin/NSAIDs/colchicine and treat pericarditis.

• #7 Management of acute pericarditis: treatment and follow-up

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Management-of-acute-pericarditis-treatment-and-follow-up

  Colchicine is recommended at low, weight-adjusted doses to improve the response to medical therapy and to prevent recurrences. Colchicine is administered as a 2-to-3-mg oral loading dose followed by 1 mg daily for three months. It is unusual not to achieve a satisfactory response to a regimen of NSAIDs with colchicine added. Colchicine has been proposed as a standard adjuvant to NSAIDs for initial treatment. […] Poorly responding patients have typically been treated with short courses of corticosteroids. Corticosteroids should be considered as a second option in patients with contraindications and failure of aspirin or NSAIDs because of the risk of favouring the chronic evolution of the disease and promoting drug dependence. In this case they are used with colchicine. However, corticosteroids should be avoided as they appear to encourage recurrences. If they simply cannot be avoided to manage an initial episode, it is recommended to use prednisone, low to moderate doses 0.2-0.5 mg/kg/day or equivalent instead of high doses (i.e. prednisone 1.0 mg/kg/day or equivalent). The initial dose should be maintained until resolution of symptoms and normalisation of CRP, then tapering should be considered.

• #8 Pericarditis – Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericarditis-treatment/

  Pericarditis – Treatment […] Outpatient management is recommended for low-risk patients who have no criteria for hospital admission. […] Consider admission/same-day consult: For diagnosis or etiologic ambiguity: Underlying etiology unlikely to be viral/idiopathic. […] Recommended Treatment of Acute Pericarditis: Restrict physical activity (minimal activity) until resolution of symptoms and normalization of CRP. […] Treat underlying condition (ex. Antibiotics for purulent pericarditis). […] First line treatment: NSAIDs OR Aspirin + Colchicine. […] Recommend GI protection with PPI. […] Second line treatment: Prednisone + Colchicine. […] In retrospective studies steroids associated with higher recurrence rate. […] Only use steroids if contraindications to NSAIDs/Aspirin or specific indication (ex. systemic inflammatory disease). […] Dosing: NSAIDs: Ibuprofen 600-800 mg po q8h. […] Aspirin 750 to 1000 mg po TID in patients with concomitant CAD. […] Colchicine: Patients > 70 kg: 0.5 mg PO BID. […] Patients < 70 kg: 0.5 mg PO daily. [...] Duration: 3 months. [...] Tapering not required. [...] Prednisone: 0.2-0.5 mg/kg/day PO. [...] Slow taper recommended (see table in Figure 1). [...] Requires exclusion of infectious (bacteria / TB) etiology. [...] If there is high clinical suspicion for cardiac tamponade, drainage of the pericardial fluid is required urgently. [...] Needle pericardiocentesis with FAST US, echocardiographic or fluoroscopic guidance. [...] Surgical drainage. [...] Follow up with primary care provider (unless consultant involved) within 7 days to ensure adequate response to treatment and monitoring of CRP. [...] Prognosis for acute viral/idiopathic pericarditis is quite good with treatment. [...] Cardiac tamponade rarely occurs. [...] Constrictive pericarditis develops in less than 1%.

• #9 Pericarditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431080/

  In most patients, empiric treatment with high-dose anti-inflammatory agents, in addition to colchicine, is recommended. Nonsteroidal anti-inflammatory drug (NSAID) therapy should continue until symptom relief is achieved, which typically occurs within 3 days to 2 weeks. […] The COPE trial randomized 120 patients to receive either conventional therapy with acetylsalicylic acid (ASA, also known as aspirin) or conventional therapy with adjunctive colchicine, following them for 18 months. […] Consequently, adjunctive colchicine therapy is now recommended for most patients with acute pericarditis for a duration of 3 to 6 months. […] Low-to-moderate doses of prednisone (0.20.5 mg/kg/d or equivalent) with a slow taper may be considered if NSAIDs or ASA and colchicine are contraindicated. […] For corticosteroid-dependent recurrent pericarditis, steroid-sparing immunosuppressive agents such as azathioprine, intravenous immunoglobulin (IVIG), or anakinra (an interleukin-1 receptor antagonist) may be considered as third-line therapy.

• #9 Pericarditis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431080/

  Pericarditis, the most common pathological condition affecting the pericardium, involves the inflammation of the pericardial sac surrounding the heart. […] Management of pericarditis includes measuring erythrocyte sedimentation rate, C-reactive protein, and troponins, along with performing tests such as complete blood count and metabolic panels to identify underlying causes. Treatment typically includes high-dose anti-inflammatory agents, colchicine, and continued nonsteroidal anti-inflammatory drug therapy until symptoms resolve. […] All patients with suspected acute pericarditis should undergo an ECG, echocardiogram, and chest x-ray. Myocardial inflammatory and injury markers, such as ESR, CRP, and troponins, should also be measured. […] Most patients will have idiopathic acute pericarditis, which can be safely managed on an outpatient basis with medical therapy alone. Activity restrictions beyond a sedentary lifestyle are advised until symptoms resolve or cardiac enzyme levels normalize.

• #10 Pericarditis: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17353-pericarditis

  Most times, people with pericarditis only need medications for pericarditis treatment, depending on the suspected cause. […] Treatment for acute pericarditis may include medication for pain and inflammation, such as ibuprofen or high-dose aspirin. […] If you have severe symptoms that last longer than two weeks, or they clear up and then return, your healthcare provider may also prescribe an anti-inflammatory drug called colchicine (Colcrys or Gloperba). […] If you need to take large doses of ibuprofen, your provider may prescribe medications to ease gastrointestinal (stomach and digestive) symptoms. […] If you have chronic or recurrent pericarditis, you may need to take NSAIDs or colchicine for several years, even if you feel well. […] If your pericarditis is caused by an infection, your provider will prescribe specific medicines to treat that infection.

• #11

  https://link.springer.com/article/10.1007/s40265-025-02169-x

  Pericarditis is the most frequent pericardial disease and presents with a relatively benign course when treated according to guideline-directed therapies at first presentation. […] The therapeutic armamentarium for pericarditis includes high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) that are tapered rapidly once symptoms are controlled. Colchicine is necessary to both relieve symptoms and reduce the rate of recurrences and is continued for at least 36 months. […] Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of the treatment of pain in acute and recurrent pericarditis. […] The use of colchicine for the treatment of recurrent pericarditis was first proposed in 1987. […] Colchicine reduces the risk of recurrences compared with NSAIDs alone and induces a longer time free from disease in both acute and recurrent pericarditis.

• #11

  https://link.springer.com/article/10.1007/s40265-025-02169-x

  Although glucocorticoids are frequently used for acute and recurrent pericarditis, no randomized clinical trials have been undertaken. […] The IL-1 blockers anakinra, rilonacept, and goflikicept are used as third-line treatment in patients with recurrent pericarditis who cannot come off glucocorticoids or as second-line therapy after NSAIDs and colchicine in patients with contraindications to glucocorticoids. […] Anakinra was tested in the AIRTRIP trial and the IRAP study in patients with recurrent pericarditis. […] Rilonacept is an engineered dimeric fusion protein made up of the extracellular portion of IL-1R1 and the IL-1 receptor accessory protein linked to the fragment crystallizable portion of the human immunoglobulin G1. […] Goflikicept is a heterodimeric fusion protein that binds both isoforms of IL-1, with a higher affinity for IL-1 than for IL-1 or IL-1Ra.

• #12 EM@3AM: Pericarditis – emDocs

  https://www.emdocs.net/em3am-pericarditis/

  Pericarditis is an inflammatory syndrome leading to granulocytic or lymphocytic infiltration of the above mentioned layers. […] Treatment: Idiopathic and viral pericarditis is likely to resolve in 1-3 weeks without any intervention. […] First Line Therapy: NSAIDS: No single NSAID appears to be more effective than another. Aspirin is preferred for any patient with a history of myocardial infarction. Treatment should be tapered until resolution of symptoms or normalization of inflammatory markers. […] Colchicine: An important adjunct that improves outcomes. The ICAP trial (RCT) revealed that the use of colchicine reduced symptoms at 72 hours, rate of recurrence, rate of hospitalizations, and time to first recurrence. […] Proton Pump Inhibitor (PPI): All patients in the ICAP trial and other previous studies received a proton pump inhibitor for gastroduodenal prophylaxis. Patients with acute pericarditis should receive a PPI for the duration of therapy with NSAIDS/Aspirin and colchicine.

• #13 Acute Pericarditis: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0500/acute-pericarditis.html

  Nonsteroidal anti-inflammatory drugs are the first-line treatment option. […] Glucocorticoids should be reserved for patients with contraindications to first-line therapy and those who are pregnant beyond 20 weeks’ gestation or have other systemic inflammatory conditions. […] Colchicine should be used in combination with first- or second-line treatments to reduce the risk of recurrence. […] Patients with a higher risk of complications should be admitted to the hospital for further workup and treatment.

• #14 Management of Acute and Recurrent Pericarditis

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/01/07/10/59/Management-of-Acute-and-Recurrent-Pericarditis

  Corticosteroids have been associated with a more prolonged disease course and a higher risk of recurrence. Accordingly, their use (at low doses) should be reserved for patients unable to take NSAID therapy or for those with specific indications (e.g., autoimmune disease, pregnancy, or immune checkpoint inhibitor-associated pericarditis). […] Purulent pericarditis is a rare but potentially life-threatening disease. It requires specific antimicrobial treatment according to the causative etiologic agent, along with pericardial drainage. […] Recurrent pericarditis may occur in up to 30% of patients after an initial episode of acute pericarditis. Treatment should consist of an NSAID, typically with a 2- to 4-week taper after the resolution of symptoms, along with at least 6 months of colchicine (with weight-adjusted dosing). Corticosteroids (at low doses) should be reserved for those who have failed multiple attempts at therapy with an NSAID plus colchicine. Anti-interleukin 1 therapy (e.g., anakinra and rilonacept) has been shown to be beneficial in patients with refractory, corticosteroid-dependent disease. Other options for consideration in refractory disease include azathioprine, methotrexate, mycophenolate mofetil, and intravenous immunoglobulins. Surgical pericardiectomy is considered a last option.

• #14 Management of Acute and Recurrent Pericarditis

  https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/01/07/10/59/Management-of-Acute-and-Recurrent-Pericarditis

  When tamponade complicates pericarditis, immediate drainage is indicated. In most cases, drainage is accomplished percutaneously with imaging guidance; some cases require surgical management. […] Constrictive pericarditis is a possible complication of nearly any pericardial disease process. Diagnosis may be challenging, and rests on integration of bedside features with characteristic echocardiographic findings. CMR is helpful to confirm the diagnosis and to assess for pericardial inflammation (shown by late gadolinium enhancement of the pericardium). Complex hemodynamic catheterization may be necessary when the noninvasive assessment is inconclusive. […] When there is evidence of inflammatory constrictive pericarditis, a course of anti-inflammatory therapy is indicated, in addition to cautious diuresis in patients with evidence of volume overload. When the constrictive process is chronic, without evidence for active inflammation, radial pericardiectomy may be required.

• #15 Acute Pericarditis – RCEMLearning

  https://www.rcemlearning.co.uk/reference/pericarditis/

  Patients who fail to respond to initial treatment within 1-2 weeks should be admitted to hospital for further assessment. […] Steroids are not indicated for acute pericarditis in the early phase as they are associated with an increased risk of relapsing pericarditis. Steroids should only be considered as first line treatment when the underlying cause is thought to be immune-mediated, due to a connective tissue disorder, or in uraemic pericarditis. […] First line drug treatment for uncomplicated acute idiopathic pericarditis is NSAIDs and colchicine.

• #15 Acute Pericarditis – RCEMLearning

  https://www.rcemlearning.co.uk/reference/pericarditis/

  The mainstay of treatment is activity restriction and symptomatic treatment in the form of anti-inflammatory Drugs (NSAIDS) […] Patients should be instructed to restrict strenuous physical activity until symptoms have resolved and biomarkers have normalized. Athletes should be advised not to compete in competitive sports for at least 3 months following resolution. […] NSAIDS are the mainstay of treatment for pericarditis (e.g. aspirin, ibuprofen, indomethacin, etc.). Aspirin is used preferentially if pericarditis is a complication of acute myocardial infarction. […] Adding colchicine to NSAIDS should be strongly considered as it has been shown to reduce symptoms, decrease the rate of recurrent pericarditis, and the low dose regimen (0.5-1.2mg daily) is generally well tolerated. […] It has been recommended that NASIDS can be stopped after resolution of symptoms but colchicine should be continued for 3 months.

• #16 Treatment of Recurrent Pericarditis – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-treatment-recurrent-pericarditis-articulo-S1885585713003174

  Recurrent pericarditis is probably the most common and troublesome complication of pericarditis, affecting about 20% to 30% of patients after a first attack of acute pericarditis. […] The aim of the present editorial is to briefly review current management strategies for recurrent pericarditis (antiinflammatory and immunosuppressive drugs, surgery) in order to provide the best evidence-based approach to the management of this complication. […] Nonsteroidal antiinflammatory drug (NSAID) are the mainstay of pericarditis treatment (class I indication, level of evidence A). […] Acetylsalicylic acid or a non-steroidal anti-inflammatory drug should be considered as first-line therapy with colchicine; prednisone is a second choice and may be added in more severe recurrence; colchicine is usually added to another antiinflammatory agent.

• #17 Tip and tricks for acute pericarditis

  https://www.escardio.org/Councils/Council-for-Cardiology-Practice-(CCP)/Cardiopractice/tip-and-tricks-for-acute-pericarditis

  Aspirin or non-steroid anti-inflammatory drugs (NSAIDs) are the mainstays of therapy for acute pericarditis. Colchicine is usually added as well because it can halve recurrences. […] Aspirin or NSAID + colchicine + exercise restriction are the first-line therapies. The second line therapy includes low-dose corticosteroids (in case of contraindications to aspirin/NSAID/colchicine and after exclusion of an infectious cause). […] Recurrent and refractory pericarditis may require a therapy such as intravenous immunoglobulins, anakinra or azathioprine, or ultimately, a pericardiectomy. […] The mainstay of treatment of pericarditis is represented by anti-inflammatory drugs, which have, however, different profiles in effectiveness and side-effects. […] Therapy should be continued according to the timelines shown in the Central illustration.

• #18 FDA approves first treatment for disease that causes recurrent inflammation in sac surrounding heart | FDA

  https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-first-treatment-disease-causes-recurrent-inflammation-sac-surrounding-heart

  FDA has approved Arcalyst (rilonacept) injection to treat recurrent pericarditis and reduce the risk of recurrence in adults and children 12 years and older. […] The efficacy and safety of Arcalyst were evaluated in a double-blind, randomized study enrolling 86 patients with symptomatic pericarditis recurrence. […] Results showed that 23 (74%) patients in the placebo arm had a recurrence compared to two (7%) patients on Arcalyst, both of whom had temporarily stopped treatment. […] Arcalyst received orphan drug designation for the treatment of recurrent pericarditis.

• #19 Constrictive Pericarditis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Pericardiectomy

  https://emedicine.medscape.com/article/157096-treatment

  Definitive care is primarily surgical (ie, pericardiectomy). Operative therapy typically leads to rapid hemodynamic and symptomatic improvements. Medical management, such as careful observation or symptomatic treatment, has been suggested in less severe cases; however, this option is controversial. […] Rilonacept, and interleukin-1 (IL-1) cytokine trap, was approved by the US Food and Drug Administration (FDA) in March 2021 to treat pericarditis and to reduce the risk for recurrence in patients aged 12 years and older. […] Diuretics have been used in the early stages of the disease to improve pulmonary and systemic congestion. However, these should be used cautiously because any drop in intravascular volume may cause a corresponding drop in cardiac output. […] In the vast majority of cases, medical management is ineffective unless a prominent inflammatory component is present.

• #19 Constrictive Pericarditis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Pericardiectomy

  https://emedicine.medscape.com/article/157096-treatment

  Transient constrictive pericarditis has been described, so those individuals with a diagnosis of constriction who are medically stable may be given a trial of conservative treatment for 2-3 months (using NSAIDs and/or steroids). […] Complete pericardiectomy is the definitive therapy and is a potential cure. […] Results are generally better if the procedure is performed earlier in the course, when less calcification is present and when the chance of abnormal myocardium or advanced heart failure is reduced. […] Pericardiectomy can be a long and often technically complex procedure. […] In published reports, surgical mortality ranges from 5% to 15%, with one report citing a 30-day perioperative mortality of 6.1%. […] Between 80% and 90% of patients who undergo pericardiectomy achieve NYHA class I or II postoperatively.

• #20 Pericarditis: Symptoms, Diagnosis, and Why Timely Management Matters.

  https://www.medstarhealth.org/blog/pericarditis-diagnosis-treatment

  MedStar Washington Hospital Center offers the most advanced diagnostic imaging, such as echocardiography, cardiac MRI, and CT. We also possess the expertise to provide advanced medications and surgery, when necessary. […] Colchicine is the frontline treatment for first-time pericarditis, along with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Colchicine is an anti-inflammatory medication that has been used for other inflammatory conditions, such as gout. Together, colchicine and NSAIDs can effectively control pericarditis symptoms and help reduce the risk of it coming back. […] Colchicine and ibuprofen typically are not enough to control symptoms in recurrent pericarditis. There are a few injectable medication options to consider: Rilonacept is a weekly injectable. It is the only recurrent pericarditis medication approved by the U.S. Food and Drug Administration (FDA). Anakinra is a once-or-twice daily injectable medication traditionally used for conditions such as rheumatoid arthritis. Though it is not FDA-approved for pericarditis, it is an alternative that can help patients. Corticosteroids can help reduce symptoms but can increase the risk of recurrence and cause side effects expected with steroids such as weight gain, sleep disturbance, and skin changes.

• #21 Recurrent Pericarditis

  https://www.arcalyst.com/recurrent-pericarditis

  Traditional therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids are often used to manage symptoms of a first episode of pericarditis. […] Treatment for recurrent pericarditis needs a different approach because traditional therapies do not specifically target the ongoing cycle of autoinflammation that causes recurrent pericarditis. […] Long-term prevention of flares requires a treatment that can break the cycle of autoinflammation. […] ARCALYST is the first and only FDA-approved therapy to treat recurrent pericarditis and reduce the risk of future flares in people 12 years and older. […] ARCALYST breaks the cycle of autoinflammation that causes recurrent pericarditis by blocking interleukin-1 (IL-1) signaling.

• #22 Patient education: Pericarditis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/pericarditis-beyond-the-basics

  Another medication, colchicine, is recommended in addition to the NSAID for most patients. In several studies, colchicine was found to improve symptoms and reduce the risk of a future (recurrent) episode of pericarditis. […] If these medications are not helpful or cannot be tolerated, a steroid (eg, prednisone) may be recommended. In most cases, the steroid dose is maintained for several days and then reduced very slowly, over a period of weeks, to reduce the risk of recurrent pericarditis. […] Treating the cause—When the cause of pericarditis is identified, treatment is aimed at the underlying condition. As an example, pericarditis that is caused by a bacterial infection would be treated with one or more antibiotics. However, viral pericarditis does not require any specific antiviral treatment in most patients and is treated by empiric anti-inflammatory therapies. This is the reason why it may be not necessary to identify the causative virus in all cases.

• #22 Patient education: Pericarditis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/pericarditis-beyond-the-basics

  Pericarditis caused by heart attack—Sometimes pericarditis and pericardial effusion occur as an early complication of a heart attack (myocardial infarction). Fortunately, the incidence of pericarditis with heart attack has sharply decreased with modern therapies that minimize the degree of heart damage. Heart attack related pericarditis is usually temporary, lasting as little as a few days. […] Another type of pericarditis, known as postcardiac injury syndrome, may develop weeks or months after a heart attack, heart surgery, or other procedures on the heart. The best treatment for this condition is unclear. In different regions of the world, either aspirin or a nonsteroidal anti-inflammatory drug (eg, ibuprofen [sample brand names: Advil, Motrin] or naproxen [sample brand names: Aleve, Naprosyn]) is preferred. Colchicine may be useful as an adjunct to another anti-inflammatory drug.

• #22 Patient education: Pericarditis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/pericarditis-beyond-the-basics

  Pericardiocentesis—Pericardiocentesis is the medical term for removal of fluid from the pericardium with a thin needle. Pericardiocentesis may be recommended for some patients with pericardial effusion or cardiac tamponade (a life-threatening complication of pericardial effusion). The procedure may be useful both as a treatment and as a tool to determine the cause of pericarditis. […] Risks of pericardiocentesis include bleeding, infection, and damage to the heart. The risk of these complications may be minimized when the procedure is done by an experienced clinician who performs the procedure on a regular basis. […] Pericardiocentesis is usually done by inserting a needle through the skin and into the pericardial effusion. The needle is guided by ultrasound or x-ray imaging (fluoroscopy). The ultrasound or fluoroscope allows the clinician to determine where the pericardial effusion is located, helping him or her to guide the needle precisely. Less frequently, the pericardiocentesis is done by making an incision and opening the chest.

• #22 Patient education: Pericarditis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/pericarditis-beyond-the-basics

  A small tube (catheter) is often left in place following pericardiocentesis to allow fluid to drain, since some fluid may remain and new fluid may continue to seep into the pericardial space. The catheter may be left in place for one to two days or more, until there is little or no new fluid drainage.

• #23 Pericarditis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/243

  Acute pericarditis is a clinical diagnosis. […] All patients should be given a non-steroidal anti-inflammatory drug as first-line treatment. Colchicine should also be given, unless the patient has tuberculous pericarditis. […] Further treatment is directed at any underlying systemic disorder.

• #24 Pericarditis – UF Health

  https://ufhealth.org/conditions-and-treatments/pericarditis

  The cause of pericarditis should be identified, if possible. […] High doses of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin are often given with a medicine called colchicine. These medicines will decrease your pain and reduce the swelling or inflammation in the sac around your heart. You will be asked to take them for days to weeks or longer in some cases. […] If the cause of pericarditis is an infection: […] Antibiotics will be used for bacterial infections […] Antifungal medicines will be used for fungal pericarditis […] Other medicines that may be used are: […] Corticosteroids such as prednisone (in some people) […] „Water pills” (diuretics) to remove excess fluid […] Other anti-inflammatory agents […] If the buildup of fluid makes the heart function poorly, treatment may include:

• #24 Pericarditis – UF Health

  https://ufhealth.org/conditions-and-treatments/pericarditis

  Draining the fluid from the sac. This procedure, called pericardiocentesis, is done using a needle, which is guided by ultrasound (echocardiography) in most cases. […] Cutting a small hole (window) in the pericardium (subxiphoid pericardiotomy) to allow the infected fluid to drain into the abdominal cavity. This is done by a surgeon. […] Surgery called pericardiectomy may be needed if the pericarditis is long-lasting, comes back after treatment, or causes scarring or tightening of the tissue around the heart. The operation involves cutting or removing part of the pericardium.

• #25 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-Options-for-Pericarditis.aspx

  If the pain persists and the underlying cause (e.g., an infection) is known, a treatment appropriate to the cause must also be begun. For instance, if tuberculosis or bacterial infection is the underlying cause, the patient may be given appropriate antibiotics. If due to a fungal infection, the patient may require systemic antifungal medication. […] For acute or recurrent pericarditis, the patient may be given a drug called colchicine as an adjunct to NSAID therapy. This drug reduces inflammation and the severity of symptoms, as well as decreasing the risk of recurrence. […] Although the NSAID/colchicine combination is generally safe and effective, some patients may have refractory symptoms. Such patients may require systemic corticosteroid therapy, prednisone often being the drug of choice.

• #25 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-Options-for-Pericarditis.aspx

  In some patients with moderate-to-large pericardial effusion which tends to cause or is causing cardiac tamponade, those with significant effusion and recurrent pericarditis, or those with evidence of constrictive pericarditis, medical interventions alone may not be sufficient. In such situations, patients may require some form of percutaneous or surgical intervention as part of their treatment protocol. […] Pericardial drainage using a catheter is an effective method to drain the excess fluid out of the pericardial sac and relieve the tamponade. Surgical puncture of the pericardial cavity for the aspiration of fluid is called pericardiocentesis. […] Surgical removal of the entire pericardium (pericardiectomy) is resorted to only when a patient has recurrent pericarditis and is refractory to appropriate medical treatment, or has recurrent cardiac tamponade. It is the definitive mode of management in such cases and has the potential to provide a permanent cure for constrictive pericarditis.

• #26 Pericarditis | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/pericarditis

  If there is evidence of significant fluid build-up around the heart, this needs to be removed by placing a narrow, flexible catheter into the pericardial space and draining the fluid, sometimes leaving the drain in for a few days to ensure all the fluid has been removed. […] If the pericarditis is felt to be the result of an autoimmune disorder, patients will require treatment for their autoimmune disease as well. […] In rare cases where the pericardium has become so scarred and thick that it is causing permanent constriction around the heart, patients will need to undergo a surgical procedure where the pericardium is removed (pericardiectomy).

• #27 Latest Treatment Approach for Recurrent Lupus Pericarditis

  https://www.acc.org/education-and-meetings/patient-case-quizzes/latest-treatment-approach-for-recurrent-lupus-pericarditis

  Latest Treatment Approach for Recurrent Lupus Pericarditis […] Acute pericarditis presents as a frequent manifestation of pericardial involvement in SLE patients. Pericarditis is an indicator of active serositis which warrants a specialist opinion for a focused management approach and appropriate adjustment of medical therapy. Our patient has evidence of moderate inflammation based on elevated laboratory marker (CRP, WSR) and pericardial delayed enhancement on cardiac MRI. Her condition would be best managed with ibuprofen, colchicine and low dose prednisone. […] Currently there are no American Heart Association/American College of Cardiology pericardial guidelines, but the 2015 European Society of Cardiology (ESC) guidelines on diagnosis and management of pericardial diseases recommends treating the predisposing systemic autoimmune disorder in patient with pericarditis. Treatment of pericarditis usually includes non-steroidal anti-inflammatory agents (NSAIDS) and colchicine; followed by addition of corticosteroid if required. The combination of the three (ibuprofen, colchicine and prednisone), „triple therapy,” might be warranted in certain cases especially with continued symptoms and frequent relapses. […] Per the 2015 ESC pericardial disease guidelines, anakinra, IVIG, and azathioprine can be considered for use in patients with corticosteroid-dependent recurrent pericarditis who are not responding to colchicine (class IIb-c). Anakinra is an interleukin-1 receptor antagonist which has a rapid onset, is effective, and is well-tolerated. […] Considering the patient’s symptoms, she was recommended to start ibuprofen, colchicine and prednisone with close follow-up in clinic. At her subsequent appointments, she will be assessed for the degree of inflammation based on her symptom burden, inflammatory markers, and a repeat cardiac MRI to determine if it would be appropriate to initiate tapering of her prednisone at rate of 5 mg every 2 weeks.

• #28 Pericarditis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pericarditis/diagnosis-treatment/drc-20352514

  If pericarditis is caused by a bacterial infection, treatment may include antibiotics. Extra fluid in the space between the pericardium’s layers also may need to be drained. […] If pericarditis causes fluid buildup around the heart, a surgery or other procedure may be needed to drain the fluid. […] Surgeries or other procedures to treat pericarditis include: […] Pericardiocentesis. In this procedure, a sterile needle or a small tube called a catheter is used to remove and drain the excess fluid from the pericardium. […] Removal of the pericardium, also called pericardiectomy. Part or all of the pericardium may need to be removed. This is done if the sac surrounding the heart stays rigid due to constrictive pericarditis.

• #29 Pericarditis: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17353-pericarditis

  When fluid builds up in the space between the pericardium, it can cause a condition called pericardial effusion. […] If fluid builds up in your pericardium (pericardial effusion) and compresses your heart, you may need a procedure called pericardiocentesis. […] If your provider can’t drain the fluid with a needle, they’ll perform a minimally invasive surgical procedure called a pericardial window. […] If you have constrictive pericarditis, you may need to have some of your pericardium removed. […] Surgery isn’t usually used as a treatment for people with pericarditis that keeps coming back because inflammation makes healing after surgery difficult, but your provider may talk to you about it if other treatments aren’t successful. […] You should respond to treatment within a week, but you could be taking medicine for two weeks. […] Recovery from surgery takes longer. It can take weeks or months for a full recovery from pericarditis.

• #30 Pericarditis: What is it, Symptoms, Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/pericarditis

  Surgery may be required for individuals with chronic fluid buildup or where pericardiocentesis is not an appropriate option. One surgical treatment option is a minimally invasive procedure known as a pericardial window. This is where a small incision is made to remove a portion of the pericardium so that fluid can drain out more easily. […] For patients with constrictive pericarditis, a pericardiectomy may be performed. This is a surgery to remove either the entire pericardium or a large portion of it. Although this surgery might not fix the cause of the inflammation, it does allow the heart to function normally again. […] Most cases of pericarditis resolve on their own, but complications can arise, especially if left untreated. The most severe complications include recurrent chest pain (affecting up to 30% of patients), life-threatening fluid buildup around the heart (in 3% of patients), and chronic heart failure due to constriction (in 1-2% of patients). Rest is essential for a full recovery, and following the prescribed treatment plan can significantly reduce the risk of pericarditis recurring. […] Many patients respond to treatment within a week, but it’s important to complete the treatment plan for the length of time prescribed. Recovery from surgery could take even longer, usually several weeks or months.

• #31 Constrictive Pericarditis: Symptoms, Causes and Treatment

  https://my.clevelandclinic.org/health/diseases/22373-constrictive-pericarditis

  Constrictive pericarditis is a condition where the pericardium, the thin membrane that holds your heart in place, becomes stiffer and thicker than normal. That interferes with your hearts pumping ability and can lead to severe problems like heart failure. It’s usually a chronic (long-term) problem, but it is treatable in most cases, especially with early diagnosis. […] This condition is usually treatable, and curing it is often possible. […] In most cases, curing this condition involves two main principles: Relieving pressure on the heart happens because the pericardium cant stretch. Treating underlying causes or related symptoms. […] Most of the time, this condition involves the following: Surgery. Pericardiectomy, which removes all of the pericardium, usually offers the best chance to treat this condition successfully. You don’t need your pericardium to survive, and many people return to their normal lives without any difficulty or long-term effects.

• #31 Constrictive Pericarditis: Symptoms, Causes and Treatment

  https://my.clevelandclinic.org/health/diseases/22373-constrictive-pericarditis

  Depending on the underlying cause and symptoms, different medications can help treat this condition’s symptoms directly or try to cure it by stopping whatever is causing it to happen. In some cases, medications are enough to treat this condition, avoiding the need for surgery, or they can help manage symptoms for people who cant have surgery. […] The most common medications for the treatment of this condition include: Diuretics. These medications help your kidneys remove extra fluid from your body. NSAIDs. Non-steroidal anti-inflammatory drugs, or NSAIDs, help reduce inflammation and relieve pain. Examples of these include ibuprofen or naproxen. Steroids. The anti-inflammatory effects of these medications can help treat this condition. Cause-specific medications. Examples of these include antibiotics for bacterial infections like tuberculosis.

• #32 Pericarditis

  https://www.racgp.org.au/afp/2017/november/pericarditis

  The most common treatment for these are nonsteroidal anti-inflammatory drugs and colchicine. […] The mainstay of treatment for acute pericarditis is pain relief and resolution of inflammation. When no contraindications exist, nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended. […] Low-dose colchicine is usually well tolerated and has infrequent side effects, mainly of gastrointestinal nature, although high doses, specifically with prolonged use, can lead to irreversible toxicity. […] It is now common practice to use colchicine for the first episode of pericarditis, unless there are specific contraindications. […] The use of glucocorticoids is controversial. […] A simple lifestyle factor such as activity restriction, especially in cases of athletes, is important as well. Refraining from strenuous activity until symptom resolution is recommended for all patients, and for at least three months after resolution of symptoms for competitive athletes. […] Moderate-to-large pericardial effusions that result in symptoms should be drained if medical management has failed.

• #33 Chronic Pericarditis – Heart and Blood Vessel Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/pericardial-disease-and-myocarditis/chronic-pericarditis

  Treatment of the underlying disorder […] Sometimes removal of the pericardial fluid or the pericardium […] For chronic constrictive pericarditis, salt restriction and diuretics to relieve symptoms. […] Known causes of chronic effusive pericarditis are treated when possible. If heart function is normal, doctors take a wait-and-see approach. […] If the disorder causes symptoms or if an infection is suspected, balloon pericardiotomy, needle drainage (pericardiocentesis), or surgical drainage may be done. […] For people with chronic constrictive pericarditis, restriction of salt in the diet and diuretics (medications that increase the excretion of fluid) may relieve symptoms. […] The only possible cure for chronic constrictive pericarditis is surgical removal of the pericardium. Surgery cures most people. However, because the risk of death from surgery is 5 to 15% (and is higher in people who have severe heart failure), most people do not have surgery unless the disease substantially interferes with daily activities.

• #34 Management of acute pericarditis: treatment and follow-up

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Management-of-acute-pericarditis-treatment-and-follow-up

  Initial management of acute pericarditis should be focused on screening for specific causes which will determine the choice of therapy. Hospital admission is recommended for high-risk patients with acute pericarditis. Colchicine use is a first-line therapy for acute pericarditis as an adjunct to aspirin/NSAIDs therapy for three months. Corticosteroids are not recommended as first-line therapy for acute pericarditis as they appear to encourage recurrences. Serum CRP should be considered to guide the treatment length and assess the response to therapy. Evaluation of response to anti-inflammatory therapy is recommended after one week.

• #35 Acute pericarditis – EMCrit Project

  https://emcrit.org/ibcc/pericarditis/

  Front-line therapy is a combination of colchicine plus either aspirin or an NSAID. […] Enormous doses should be utilized to treat underlying inflammation. Failure to use an adequate dose may lead to analgesia without adequate treatment of the underlying disease process (which may lead to disease recurrence). […] These therapies usually relieve chest pain within days. […] Duration of therapy is usually 7-14 days at maximal dose. Depending on the persistence of symptoms and CRP level, a gradual taper may be instituted over 3-4 weeks. […] Continue for three months (well past the resolution of symptoms and inflammatory markers). […] Acute pericarditis is generally exquisitely sensitive to steroid therapy. However, steroids should be avoided if possible because it frequently leads to steroid dependence.

• #36 What Is Pericarditis? | American Heart Association

  https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis

  Pericarditis is frequently mild and may clear up on its own with rest or simple treatment. […] Sometimes, more intense treatment is needed to prevent complications. […] Recovery time from pericarditis may vary depending on the type of condition, the cause and the patient’s health. Consultation with a health care professional can determine this. […] Among those treated for acute pericarditis, 15% to 30% may experience the condition again if not treated with the medication colchicine.

• #37 Living with chronic pericarditis

  https://www.medicalnewstoday.com/articles/living-with-chronic-pericarditis

  Pericarditis can last for only a short while. However, people can experience recurrent pericarditis flares for months or even years. […] Treatment for recurrent (chronic) pericarditis can take many years. People with the condition may receive around 4.7 to 6.2 years of treatment with anti-inflammatory medications, according to a 2023 analysis. During this time, careful management and lifestyle adjustments may be necessary to prevent complications. […] Treatment for chronic pericarditis often involves surgery to treat constriction or effusion. […] Treatment for acute pericarditis aims to use medications to relieve pain and inflammation, and to address the underlying infection. This often involves: colchicine, an anti-inflammatory medication; anti-inflammatories such as aspirin and ibuprofen; prednisone, a steroid for pericarditis not responsive to traditional anti-inflammatory treatment; If the symptoms of acute pericarditis return (recurrent pericarditis), then IL-1 inhibitors could be used to treat the RP and reduce the risk of future recurrences.

• #38 Evaluation and Treatment of Pericarditis: A Systematic Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/26461998/

  Pericarditis is the most common form of pericardial disease and a relatively common cause of chest pain. […] The most common treatment for idiopathic and viral pericarditis in North America and Europe is NSAID therapy. Adjunctive colchicine can ameliorate the initial episode and is associated with approximately 50% lower recurrence rates. Corticosteroids are a second-line therapy for those who do not respond, are intolerant, or have contraindications to NSAIDs and colchicine. Recurrences may occur in 30% of patients without preventive therapy. […] Appropriate triage and treatment with NSAIDs may reduce readmission rates for pericarditis. Treatment with colchicine can reduce recurrence rates.

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