Acute pericarditis is an inflammatory condition of the pericardium presenting primarily with chest pain. First-line management targets full symptom resolution and prevention of recurrences through a structured combination of non-pharmacological and pharmacological interventions.

Treatment Approach

Management begins with restriction of physical activity and empirical anti-inflammatory therapy, with an adjunctive agent added specifically to reduce the risk of recurrences — alongside gastroprotection as part of the regimen.

The full protocol details agent selection, dose tapering schedules, and management considerations for patients who remain symptomatic despite initial therapy — available via the link below.

Treatment Goal

Clinical remission: full regression of pericarditis symptoms (chest pain) and normalisation of C-reactive protein.

References

DOI: 10.1093/eurheartj/ehaf192

An important non-pharmacological concept is the restriction of physical activity beyond sedentary activities until symptom resolution and clinical remission with normalization of inflammatory markers.
The mainstay of medical therapy is empirical anti-inflammatory therapy using aspirin or NSAIDs at full anti-inflammatory doses with appropriate time intervals of administration (usually every 8 h) plus colchicine to reduce the risk of recurrences.
Gastroprotection with a proton pump inhibitor is recommended using NSAIDs.
Clinical remission is defined as full regression of symptoms, as well as normalization of laboratory results (e.g. C-reactive protein, troponin levels) and investigations (ECG, evidence of PEff, CMR evidence of active inflammation).

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What Is the First-Line Treatment for Acute Pericarditis?

Treatment Approach

References