Pericarditis Management

Diagnosis and Initial Evaluation

The European Society of Cardiology recommends confirming the diagnosis with at least 2 of the following: sharp, pleuritic chest pain, new widespread ECG changes, new or increased pericardial effusion, or pericardial friction rub, and evaluating inflammatory markers, cardiac injury markers, and performing echocardiography and chest X-ray 1
A patient with pericarditis presenting with a new onset murmur requires immediate comprehensive evaluation with transthoracic echocardiography to rule out cardiac tamponade or effusive-constrictive pericarditis, as these conditions can significantly increase morbidity and mortality 1
Immediate transthoracic echocardiography should assess pericardial effusion size and location, signs of tamponade, valvular function and structure, ventricular function, and evidence of constrictive physiology 1
Laboratory assessment should include inflammatory markers, cardiac injury markers, and blood cultures if infectious etiology is suspected 1
ECG should evaluate for signs of pericarditis, myocardial involvement, and low voltage 1
Chest X-ray should assess cardiac silhouette and pulmonary involvement 1

The European Society of Cardiology recommends first-line treatment with high-dose aspirin (750-1000 mg every 8 hours) or NSAIDs (ibuprofen 600 mg every 8 hours) plus colchicine (0.5 mg once daily if <70 kg or 0.5 mg twice daily if ≥70 kg) for 3 months, with treatment duration guided by symptom resolution and normalization of inflammatory markers 1, 2
Aspirin should be given at a dose of 750-1000mg every 8 hours (1.5-4g/day) for 1-2 weeks with gastroprotection, then tapered 2
Colchicine should be given at a dose of 0.5mg once daily (<70kg) or 0.5mg twice daily (≥70kg) for at least 3 months 2
The European Society of Cardiology recommends providing gastroprotection with NSAIDs or aspirin 1
Activity restriction is recommended until symptoms resolve and CRP normalizes (minimum 3 months for athletes) 1, 2
Corticosteroids should be avoided as first-line therapy due to increased risk of recurrence and chronicity 2, 1

The European Society of Cardiology reports a risk of constrictive pericarditis of less than 1% in idiopathic cases and 20-30% in bacterial cases 1
The European Society of Cardiology recommends considering colchicine for at least 6 months for multiple recurrences or steroid-dependent cases 1
Evaluation for recurrence, which occurs in 15-30% of cases without colchicine (reduced to 8-15% with colchicine), is recommended 2
Hospitalization is recommended for patients with fever >38°C, subacute onset, large pericardial effusion, tamponade, or immunosuppression 1

The European Society of Cardiology recommends pericardiectomy for constrictive pericarditis, though transient forms may respond to anti-inflammatory therapy 1
Urgent pericardiocentesis is recommended as first-line treatment for cardiac tamponade or effusive-constrictive pericarditis 1
Echocardiographic or fluoroscopic guidance should be used during the pericardiocentesis procedure 1

Weekly clinical evaluation and serial echocardiography should be performed to monitor murmur and pericardial changes 2
CRP should be monitored to guide treatment duration 2
Repeat echocardiography should be performed to monitor resolution of murmur and pericardial changes 2
Anti-inflammatory therapy should be continued until complete resolution of symptoms and normalization of CRP 2