Treatment of pericarditis

It is desirable to be hospitalized for the prevention or early treatment of possible complications of pericarditis. Medicines that can cause disease (eg, anticoagulants, procainamide, phenytoin) are canceled. With cardiac tamponade, urgent pericardiocentesis is performed (Figure 78-2), removing even a small volume of fluid can be a salvation for the patient.

Pain can usually be treated with acetylsalicylic acid at a dose of 325-650 mg after 4-6 hours or with another NSAID (eg, ibuprofen 600-800 mg after 6-8 hours) for 1-4 days. Colchicine at a dose of 1 mg / day, added to NSAIDs or designated as monotherapy, can be effective in the onset of pericarditis and helps prevent relapse. The intensity of therapy depends on the severity of the patient's condition. With severe pain, you can prescribe opiates and glucocorticoids (for example, prednisolone 60-80 mg 1 time per day for 1 week, followed by a rapid dose reduction). Glucocorticoids are particularly effective in acute pericarditis caused by uremia or connective tissue diseases. Anticoagulants are usually contraindicated in acute pericarditis, as they can cause intrapericardial bleeding and even a fatal tamponade of the heart; at the same time they can be prescribed in the early period of pericarditis, which complicates acute myocardial infarction. Occasionally, a pericardial dissection is necessary.

Infectious process is treated with the use of certain antibacterial drugs. It is often necessary to completely remove pericardial effusion.

At a postpericardiotomy syndrome, a postinfarction syndrome or an idiopathic pericardium antibiotics are not appointed or nominated. NSAIDs in therapeutic doses can reduce pain and effusion. If necessary, to relieve pain, fever and fluid accumulation, prednioelon 20-60 mg once a day for 3-4 days can be used. If positive dynamics are noted, the dose is gradually reduced with cancellation of the drug after 7-14 days. However, sometimes a treatment of many months is required.

With pericarditis caused by acute rheumatic fever, other connective tissue diseases or a tumor, therapy is directed to the main process.

For pericardial effusion resulting from trauma, surgical intervention is sometimes necessary to repair the wound and evacuate the blood from the pericardium.

Uremical pericarditis may occur with an increase in the frequency of hemodialysis, aspiration or administration of glucocorticoids systemically or intrapericardially. It may be effective to administer triamcinolone into the pericardial cavity.

Chronic effusion is best treated by acting on the cause, if it is known. With persistent or relapsing swelling accompanied by clinical symptoms, balloon pericardiotomy, surgical pericardial window or drug sclerotherapy (for example, tetracycline) are possible. With recurrent efflux resulting from a malignant tumor, sclerosing agents can be prescribed. The asymptomatic effusion of an unknown cause may require only observation.

The accumulation of fluid in chronic constrictive pericarditis can be reduced by bed rest, restriction of table salt and diuretics. Digoxin is prescribed only with atrial arrhythmias or systolic ventricular dysfunction. With constrictive pericarditis with clinical symptoms, pericardial excision is usually performed. However, patients with moderate manifestations, severe calcification or extensive myocardial damage may have a poor prognosis in surgical interventions. Mortality in pericardial resection is approaching 40% in NYHA class IV heart failure patients. With constrictive pericarditis due to radiation or connective tissue diseases, serious damage to the myocardium is especially likely, so the chances of improving the condition after a pericardial resection are small.