Pericarditis may be responsible for up to 5 percent of all non-heart attack chest pain cases in accident and emergency departments, according to a report in the journal The Lancet. Pericarditis is usually acute, developing suddenly and lasting only up to a few months. But it can also be chronic and last for years. Treatment of pericarditis differs depending on whether it’s acute or chronic, how severe the condition is, and what caused it.
Pericarditis Medications
The most common symptom of pericarditis is a sharp, stabbing chest pain, which may feel like chest pain from a heart attack. The first line of treatment for acute pericarditis is high doses of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, which can help reduce pain, inflammation, and fever, another common symptom of pericarditis. Stronger medications, such as colchicine (Colcrys) and the steroid prednisone, may be used if the chest pain is severe. These medications are also helpful if symptoms last more than two weeks, or recur weeks or months later. Other drugs may help treat acute pericarditis, including:
Antibiotics for pericarditis caused by bacteriaAntifungal drugs for pericarditis caused by fungiDiuretics, or water pills, to remove excess fluid
If you have chronic or recurrent pericarditis, you may need to take colchicine or NSAIDs for years, even if you’re feeling well. Pericarditis generally clears up with medications, but complications may eventually develop, requiring surgical treatments.
Pericardiocentesis
A medical emergency called cardiac tamponade develops when too much fluid builds up in the pericardium, the sac that surrounds your heart. It puts pressure on the heart, affecting its ability to pump blood. To drain this fluid, your doctor will have you undergo a procedure called pericardiocentesis. During pericardiocentesis, your doctor will apply an anesthetic (numbing medication) to the area below the breastbone or the left nipple. A needle will then be inserted into the pericardium using echocardiography — an imaging technique that uses sound waves — to help guide the procedure. Your doctor will then replace the needle with a catheter, and use the tube to drain the fluid. If the excess fluid cannot be drained using pericardiocentesis, your doctor may use a more invasive procedure called pericardial window. This procedure requires a small hole to be cut in the pericardium, allowing the fluid to drain into the chest cavity.
Pericardiectomy
Another complication that requires surgical treatment is called chronic constrictive pericarditis. Chronic constrictive pericarditis is the result of scar-like (fibrous) tissue that develops on the pericardium from inflammation. The rigid tissue contracts over time, interfering with the heart’s ability to fully expand and fill with blood. Pericardiectomy — a procedure to remove the pericardium — is the only known cure for chronic constrictive pericarditis. During a pericardiectomy, which is conducted under general anesthesia, your doctor will make an incision through the breastbone in the middle front part of your ribs, and then remove your pericardium from your heart. To complete the procedure, she will wire your breastbone and ribs back together, and stitch up the incision.
