Acute pericarditis
Your treatment plan
The medical staff involved in your care will first assess whether it is safe to treat you at home, or whether the risk of complications is high enough for you to be admitted to hospital as a precaution.
Factors that usually lead to an admission to hospital include:
- having a high temperature (fever) of or above 38C (100.4F)
- having a high number of white blood cells – this could be the result of a serious infection
- your symptoms developing after a sudden injury to your chest
- a history of taking blood thinning medication
- blood tests showing that you have high levels of a type of protein called troponin in your blood (this can be the result of damage to the heart muscle)
Hospital admission may also be recommended if you fail to respond to the treatment discussed below.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Most cases of pericarditis can be successfully treated with non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs work by reducing the inflammation of the pericardium. They also relieve the chest pain.
Ibuprofen is the preferred choice of NSAID. The exception is if you have recently had a heart attack, as ibuprofen can interfere with the healing of your heart. In such circumstances, high-dose aspirin will usually be recommended.
As NSAIDs can occasionally cause stomach ulcers, you will probably be prescribed an additional medication called a proton pump inhibitor that provides protection against stomach ulcer.
Colchicine
Colchicine is an additional medicine that can be used if:
- Your symptoms fail to respond to NSAIDs.
- You are unable to take NSAIDS because of a pre-existing medical condition.
Colchicine is useful because it kills some of the cells of the immune system that cause inflammation, so can reduce inflammation of the pericardium.
Side effects of colchicine include:
- abdominal pain
- vomiting
- diarrhoea
These side effects usually improve once your body gets used to the medication.
Corticosteroids
Corticosteroids are usually only given when the symptoms of pericarditis fail to respond to NSAIDs and colchicine, or there is a build-up of fluid inside the pericardium, which could put the heart at risk.
Corticosteroids block the effects of the immune system, leading to a reduction in inflammation.
Corticosteroids are powerful medicines and can have a range of side effects, especially if used for a long period of time.
Side effects of corticosteroids include:
- weight gain
- thinning of the skin
- mood swings
- increased sweating
- increased vulnerability to infection
Recurring pericarditis
NSAIDs can be used to relieve symptoms of an episode of pericarditis, while a long-term course of colchicine has proved effective in preventing the return of symptoms.
If medications fail to control symptoms then a short-course of steroid medication may be recommended.
If your symptoms are particularly severe and are not responding to medication, then a type of surgery known as pericardiectomy may be recommended.
This involves the surgeon making a large incision in your chest and removing some or all of your pericardium.
It should be stressed that a pericardiectomy is usually regarded as a last resort, as the surgery is relatively risky – there is an estimated 1 in 20 chance of it causing death.
