April 23, 2016


How is pericarditis treated?
Treatment for acute pericarditis (sudden onset) may include medication for pain and inflammation, such as nonsteroidal anti-inflammatory drugs, including ibuprofen in large doses. Depending on the cause of your pericarditis, your doctor may prescribe an antibiotic (for bacterial pericarditis) or an antifungal medication (for fungal pericarditis).

If your symptoms last longer than two weeks or recur over subsequent months, your doctor may prescribe an anti-inflammatory drug called colchicine in combination with the ibuprofen. Colchicine is an older and well-established anti-inflammatory drug that can help control the inflammation and prevent pericarditis from recurring weeks or even months later.

When high doses of ibuprofen are prescribed, your doctor may prescribe medications to offset gastrointestinal symptoms. If you are taking high doses of nonsteroidal anti-inflammatory drugs, you should be monitored with frequent follow-up appointments to evaluate changes in kidney or liver function.

A small number of patients will develop chronic pericarditis, a condition that persists despite treatment, or that comes back (recurrent pericarditis). These patients may need to take nonsteroidal anti-inflammatory drugs or colchicine for several years, even when they are feeling well.

Previous treatment included the use of steroids, such as prednisone; however, this has been found in many cases to cause dependency on the medication to prevent a return of symptoms. In addition, steroids can reactivate the original viral infection. Furthermore, some patients can become dependent on narcotics for pain control.

Are procedures needed to treat pericarditis?

For most people with pericarditis, treatment with medications is all that is needed to clear up the inflammation and surgery is not usually necessary.
Sometimes fluid builds up in the pericardium, causing the heart to be compressed. If this occurs, you may need to undergo pericardiocentesis – a procedure to drain the excess fluid with a catheter. The doctor will use echocardiography to safely guide the placement of a large needle and catheter into the pericardium to remove excess fluid. If the fluid cannot be drained with a needle, then a surgical procedure called a pericardial window is performed.

Surgery may be needed for some patients with constrictive pericarditis. Pericardiectomy is the surgical treatment of pericarditis that involves the removal of a portion of the pericardium. Surgery is rarely done for pain control of recurrent pericarditis.

Possible Complications of Pericarditis
Constrictive Pericarditis:
Constrictive pericarditis is a severe form of chronic pericarditis in which the inflamed layers of the pericardium stiffen, develop scar tissue, thicken and stick together. The thick, rigid pericardium constricts the heart’s normal movement so that it cannot expand normally as it fills with blood. As a result, the heart chambers don’t fill up with enough blood. The blood then backs up behind the heart, causing symptoms of heart failure, including shortness of breath, swelling of the legs and feet, water retention and disturbances in the heart’s normal rhythm. These symptoms should improve when the constrictive pericarditis is treated.

Constrictive pericarditis often can be treated with a diuretic, such as furosemide, to treat the fluid retention. If you develop a heart rhythm problem, you may need to take a medication to treat the irregular rhythm for as long as the constrictive pericarditis lasts or until your heart rhythm returns to normal. When none of these treatments is effective, pericardiectomy may be needed to surgically remove the stiffened pericardium.

Pericardial Effusion
When an excess of fluid builds up in the space between the pericardium, it can cause a condition known as pericardial effusion. Rapid fluid accumulation in the pericardium can cause cardiac tamponade, a severe compression of the heart that impairs its ability to function. Cardiac tamponade resulting from a pericardial effusion can be life-threatening and is a medical emergency requiring emergent drainage of the fluid with a catheter.

What is the outlook after pericarditis?
In most people, pericarditis persists for up to three months then goes away and does not come back.
After you recover from the illness, you should be able to return to your normal activities without any reason for concern. Your doctor will talk to you about what you can expect and any activity limitations depending on your age, health, activity level and the cause of your pericarditis.
Sometimes the attacks recur every few months and anti-inflammatory medications are needed for years to manage symptoms.

Glossary of Pericarditis Terms
    Acute pericarditis: Inflammation of the pericardium that develops suddenly and is accompanied by the sudden onset of symptoms.
    Cardiac tamponade: A severe compression of the heart that impairs its ability to function. Cardiac tamponade is a medical emergency that requires prompt diagnosis and treatment. Chronic pericarditis: Inflammation of the pericardium that lasts for three months or longer after the initial acute attack.
    Constrictive pericarditis: A severe form of pericarditis in which the inflamed layers of the pericardium stiffen, develop scar tissue, thicken and stick together. Constrictive pericarditis interferes with the normal function of the heart.
    Infectious pericarditis: Pericarditis that develops as the result of a viral, bacterial, fungal or parasitic infection.
    Idiopathic pericarditis: Pericarditis that does not have a known cause.
    Pericardium: The thin, two-layered, fluid-filled sac that covers the outer surface of the heart.
    Pericardial effusion: Excess fluid build-up in the pericardium.
    Pericardial window: A minimally invasive surgical procedure performed to drain fluid that has accumulated in the pericardium. This surgical procedure involves a small chest incision through which an opening is made in the pericardium.
    Pericardiectomy: Surgical treatment of pericarditis that involves the removal of a portion of the pericardium.
    Pericardiocentesis: A procedure performed to drain excess fluid from the pericardium with a catheter.
    Traumatic pericarditis: Pericarditis that develops as the result of injury to the chest, such as after a car accident.
    Uremic pericarditis: Pericarditis that develops as the result of kidney failure.

1 comment:

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