Pericarditis

Treatment Overview

Viral pericarditis usually improves on its own with time. Mild pain relievers may be all you need to relieve inflammation and control pain. Bacterial pericarditis requires antibiotics in addition to pain relievers.

Other conditions that may be the cause of the pericarditis (underlying conditions) will also be treated.

If complications develop and pressure on the heart (cardiac tamponade) is a concern, your doctor may need to drain fluid from the pericardial sac.

Medications

Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and relieve the pain of pericarditis. Occasionally, other stronger medicines are also used for pain relief. NSAIDs are typically used for about 4 weeks, but may be used longer.

Another type of medicine called colchicine may be used to treat pericarditis and prevent repeat (recurrent) episodes. Colchicine may be tried if other medicines do not improve your pericarditis. Colchicine also reduces inflammation, but it works differently than NSAIDs. Colchicine may be used along with NSAIDs. Colchicine is typically used for about 3 months, but may be used longer.

In rare cases, your doctor may prescribe stronger anti-inflammatory medicines called corticosteroids, such as prednisone. Corticosteroids are usually used only for severe inflammation that does not respond to milder medicines. In some cases, corticosteroids may make pericarditis worse.¹

If a bacterial infection is causing pericarditis, your doctor will prescribe antibiotics to treat it.

Be sure to report to your doctor any medicines that you are already taking. If you have pericarditis, taking anticoagulant medicines can cause bleeding into the pericardial space (hemorrhagic pericardial effusion).

Medical procedures

Your doctor may drain excess fluid buildup (pericardial effusion) in the area between the pericardium and the heart in a procedure called pericardiocentesis. This procedure is also done to reduce pressure (cardiac tamponade) around the heart. Pericardiocentesis involves using a needle and sometimes a thin tube called a catheter to drain the fluid. The need for pericardiocentesis is usually determined by how well the heart is functioning. If fluid builds up gradually and the heart is tolerating the increased fluid around it, treatment of the underlying cause may be tried first.

Constrictive pericarditis

Constrictive pericarditis is a rare complication of pericarditis that can keep the heart from pumping well. Some people develop shortness of breath, swollen legs and feet, and other symptoms of heart failure.

Your doctor may recommend a low-sodium diet, medicines such as diuretics to reduce your heart's workload, and limited activity. If symptoms persist and are severe, you may need surgery to remove the scarred part of the pericardial sac. This helps loosen the pericardium's tight hold around the heart and allows the heart to pump more effectively.

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Author:	Robin Parks, MS	Last Updated: May 2, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology Kathleen Romito, MD - Family Medicine
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