Resources

Management of Acute and Recurrent Pericarditis

The following information provides simple, key information, using terminology that is more widely understood. The following information is designed to help patients manage acute and recurrent pericarditis recommended by the Journal of the American College of Cardiology

Pericarditis refers to the swelling or inflammation of the pericardial layers, which is a sac-like tissue that surrounds the heart. This swelling can happen from an outside cause (viral/bacterial infections or heart procedures), or changes that happen from the inside of the body (autoimmune disorders or cancer). Most often the cause is unknown. There are four (4) types:

• Acute pericarditis begins suddenly but usually does not last longer than 6 weeks. Treatment is not always needed, and symptoms may go away on their own.
• Incessant pericarditis lasts beyond four to six weeks without relief from symptoms.
• Recurrent pericarditis Symptoms that return after being symptom free for 4 to 6 weeks.
• Chronic pericarditis Symptoms that last longer than three months. Usually does not begin suddenly; symptoms come on more slowly and continue to increase over time.

Symptoms are often described as sharp or stabbing pain, which may feel like a heart attack, but may improve when sitting down and leaning forward. Pain may feel worse when breathing in, coughing, or lying flat.

A healthcare worker is necessary to diagnose pericarditis. They will ask specific questions about symptoms, medical history and complete a physical examination. Tests include bloodwork to check for signs of inflammation and an Echocardiogram (ultrasound of the heart) to check for fluid buildup around the heart. Alternate imaging such as Cardiac Magnetic Resonance imaging (CMR) may be used for more severe or recurring pericarditis. CMR can help detect whether the heart muscle is affected but use may be limited if the patient has an abnormal heart rhythm such as atrial fibrillation (A-Fib), a pacemaker or kidney disease.

If treatment is needed, medications that will decrease swelling and inflammation in the body are used first. This includes nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, and colchicine. If symptoms reappear, these medications may be needed for months instead of weeks. If unable to take NSAIDs or longer treatment is needed, medications that lower the body’s immune system response (steroids, IL-1 blockers) may be used. In addition to treatment of inflammation, use of medications to protect the stomach, lower heart rate, or remove excess fluid (diuretics) may be added as needed.

The rare occasions that the heart is not able to pump effectively because of fluid buildup (pericardial effusion) or stiffening of the tissue around the heart (constrictive pericarditis), surgical procedures may be performed.

For more information and complete text on Management of Acute and Recurrent Pericarditis: https://pericarditisalliance.org//wp-content/uploads/2023/03/ChiabrandoJACC2019.pdfhttps://www.sciencedirect.com/science/article/pii/S1936878X19308794?via%3Dihub