Inflammation of the sac-like outer covering of the heart of short duration is termed as acute pericarditis. This inflamed condition is provoked by an infection by virus, a prior heart attack, any trauma to the chest, any allergy reaction to medicine, and many others. Most of the patients with acute pericarditis experience acute chest pain and confuse with a heart attack, driving them to bend forward to fetch relief. Normal cases settle down with the proper rest and simple medications. Life-threatening cases may require emergency treatment mostly hospitalization to stabilize the patient.
How is Acute Pericarditis Treated?
Acute pancreatitis may be present for few days to 3 weeks. The main aims of the treatment of acute pericarditis are
- Primary relief of pain and control of inflammation
- Removal of underlying cause
- Prevention of complications
The physician plans treatment of the patient by thoroughly observing the current symptoms, medical history, estimated cause and reaction to previous courses of treatment. Once the diagnosis of the disease is confirmed, patient reflecting higher risk are admitted to the hospital. The main suggestive reasons of hospitalization are-
- Fever above 38C
- Leukocytosis
- Pericardial effusion of severe nature
- Patient with low immunity
- Acute injury to the chest
- Patients using warfarin
- Unresponsiveness to inflammatory medicines
- Development of cardiac tamponade
- Increased cardiac troponin
Treatment of Acute pericarditis is based on the cause of the disease. It can be understood by following points-
- Complete rest is advised to the patient. Any vigorous physical activity should be avoided to reduce the symptoms. Rest is recommended until the patient feels better or fever goes away.
- Anti-inflammatory drugs NSAIDs are prescribed as the first line of treatment to control inflammation and pain. They are prescribed for one to two weeks and doses are reduced with the reduction of the symptoms and improvement of the inflammation.
- If the pain is not reduced by NSAIDs and its severity continues to remain the same, colchicine is prescribed. It is given in combination with NSAIDs to the patients who represent recurrent or persistent symptoms beyond 14 days. This course of medicines reduces the chance of stronger attack of the disease in future.
- If the causation of the disease is an infection, then antiviral or antibiotics or antimicrobials are given according to the causative organism.
- If the patient is taking any drugs like phenytoin that may cause pericarditis, it is stopped immediately.
- Proton pump inhibitors (PPIs) are prescribed to enhance gastric protection especially to the patients who are on the high doses of NSAIDs.
- The patient is kept in the hospital during the treatment to monitor the action of medicines and any possibility of complication.
- In case the cause of pericarditis is acute myocardial infarction, then anticoagulants should be restricted.
- Corticosteroids are recommended as the second line of treatment to modify immunity and it is not preferred until the underlying disease indicate its need or patient is nonresponsive to NSAIDs or colchicine. This is because NSAIDs or colchicine and corticosteroids are contradicted.
- In case of uremic pericarditis, the frequency of dialysis is increased, a systemic or local steroidal therapy and aspiration therapy may be indicated.
Treatment for complications of acute pericarditis can be:
The acute pericarditis may show two major complications; these are cardiac tamponade and constrictive pericarditis.
If cardiac tamponade develops at a faster pace with fall of blood pressure with an attack of shock, emergency management is immediately required. A procedure named pericardiocentesis is done to relieve the pressure on the heart.
The only treatment for chronic constrictive pericarditis is the surgical removal of the membranous sac i.e. pericardium. This procedure is termed as pericardiectomy.
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