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עברית
November 27, 2024
Written by Caitlin Nicholson
Acute pericarditis is a common cause of nonischemic chest pain. In North America, it is typically idiopathic, develops after a viral infection, or follows a cardiac procedure. In areas with higher prevalence, tuberculosis can be an underlying cause of pericarditis. For the majority of patients, treatment with NSAIDs and colchicine leads to a favorable prognosis.
Don’t break my heart, my achy breaky heart…
This review outlines up to date guidelines on diagnosis, treatment and prognosis of patients with suspected acute or recurrent pericarditis based on 53 articles published between 2014 and 2024. We did a Spoon Feed review about 4 years ago.
Diagnosis: Acute pericarditis can be diagnosed with 2 or more of the following findings: nonischemic pleuritic chest pain (often worse when supine), widespread ST-segment elevation and PR depression on ECG, a new or worsening pericardial effusion, or a pericardial friction rub. Recurrent pericarditis is when symptoms return after remission for 4-6 weeks. Incessant pericarditis is when symptoms last at least 4-6 weeks. For most acute cases, inflammatory markers will be elevated.
Treatment: The current treatment recommendation for acute pericarditis is a combination of NSAIDs and colchicine. A 2013 study found a decrease in development of incessant or recurrent pericarditis in patients who received 3 months of colchicine (absolute risk reduction of 20.8%). Treatment for recurrent pericarditis can include corticosteroids or interleukin-1 blockers such as anakinra and rilonacept; however, sufficient studies are lacking regarding treatment recommendations for these patients. If tuberculosis is suspected, treatment should focus on addressing the infection.
Prognosis: Patients who develop acute idiopathic or viral pericarditis have recurrence risk of 15-30%, with the majority occurring within 3-6 months of initial presentation. Underlying autoimmune disease or persistently elevated CRP despite treatment are at higher risk of developing recurrent pericarditis.
How will this change my practice?
This article offers an excellent review of a common ED diagnosis. It highlights the importance of early, aggressive treatment for first-time acute pericarditis. Recurrent or incessant pericarditis can significantly affect quality of life due to persistent chest pain. If recurrence is suspected, extending colchicine for an additional 3 months and adding steroids, along with cardiology follow-up, are appropriate first steps.
Source
Diagnosis, Risk Stratification, and Treatment of Pericarditis: A Review. JAMA. 2024 Oct 1;332(13):1090-1100. doi: 10.1001/jama.2024.12935. PMID: 39235771
