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Treatment of pericarditis
Last reviewed: 06.07.2025
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Hospitalization is desirable to prevent or treat early possible complications of pericarditis. Drugs that can cause the disease (for example, anticoagulants, procainamide, phenytoin) are discontinued. In case of cardiac tamponade, urgent pericardiocentesis is performed (Fig. 78-2); removal of even a small volume of fluid can be lifesaving for the patient.
Pain can usually be relieved with aspirin 325–650 mg q 4–6 h or another NSAID (eg, ibuprofen 600–800 mg q 6–8 h) for 1–4 days. Colchicine 1 mg/day added to NSAIDs or given alone may be effective at the onset of pericarditis and may help prevent recurrences. The intensity of therapy depends on the severity of the patient’s condition. If pain is severe, opiates and glucocorticoids (eg, prednisolone 60–80 mg once daily for 1 week, followed by rapid tapering) may be used. Glucocorticoids are particularly effective in acute pericarditis secondary to uremia or connective tissue disease. Anticoagulants are usually contraindicated in acute pericarditis because they can cause intrapericardial hemorrhage and even fatal cardiac tamponade; however, they can be used in the early stages of pericarditis complicating acute MI. Rarely, pericardial incision is necessary.
The infectious process is treated with certain antibacterial drugs. Complete removal of the pericardial effusion is often necessary.
Antibiotics are not prescribed for postpericardiotomy syndrome, postinfarction syndrome or idiopathic pericarditis. NSAIDs in therapeutic doses can reduce pain and effusion. If necessary, prednisolone can be used at 20-60 mg once a day for 3-4 days to relieve pain, fever and fluid accumulation. If positive dynamics are noted, the dose is gradually reduced and the drug is discontinued after 7-14 days. However, sometimes treatment lasting several months is required.
In pericarditis caused by acute rheumatic fever, other connective tissue diseases or a tumor, therapy is aimed at the underlying process.
For pericardial effusion resulting from trauma, surgery is sometimes necessary to repair the wound and drain blood from the pericardium.
Uremic pericarditis may occur with increasing frequency of hemodialysis, aspiration, or administration of systemic or intrapericardial glucocorticoids. Intracardial triamcinolone may be effective.
Chronic effusions are best treated by treating the cause, if known. Symptomatic persistent or recurrent effusions may be treated with balloon pericardiotomy, surgical creation of a pericardial window, or drug sclerotherapy (eg, with tetracycline). Recurrent effusions due to malignancy may require sclerosing agents. Asymptomatic effusions of unknown cause may require observation only.
Fluid accumulation in chronic constrictive pericarditis can be reduced by bed rest, salt restriction, and diuretics. Digoxin is reserved for atrial arrhythmias or ventricular systolic dysfunction. Symptomatic constrictive pericarditis is usually treated with pericardial resection. However, patients with moderate symptoms, severe calcification, or extensive myocardial involvement may have a poor prognosis with surgery. The mortality rate with pericardial resection approaches 40% in patients with NYHA functional class IV heart failure. Constrictive pericarditis due to radiation or connective tissue disease is particularly likely to have severe myocardial involvement, so the chances of improvement with pericardial resection are small.