Treatment of Idiopathic Pericarditis in Recurrent Pericarditis After an Initial Episode of Acute Pericarditis
Patients who have already experienced a confirmed initial acute pericarditis episode and go on to develop recurrence represent a specific clinical population. This protocol addresses their management.
Clinical Scenario
Recurrence occurs in 15% to 30% of patients after an initial episode of acute pericarditis. A first recurrence typically presents within 18 months, with findings similar to the initial episode — pleuritic chest pain, diffuse ST-segment elevations, a pericardial friction rub, and elevated serum markers of inflammation.
Treatment Goals
The clinical objectives are improvement and resolution of symptoms — including pleuritic chest pain and pericardial friction rub — and normalization of elevated serum markers of inflammation.
Approach — Partial Overview
For recurrent pericarditis, an NSAID combined with colchicine forms the foundation of therapy — but the course is more prolonged than for an initial episode, with gradual tapering after symptom improvement and concurrent gastric protection. The complete regimen, selection criteria, and duration guidance are available in the full protocol.
References
DOI: 10.1161/CIRCULATIONAHA.111.066365
- One or more recurrences arise in 15% to 30% of patients after an initial episode of acute pericarditis.
- A first recurrence typically presents within 18 months, and findings are similar to the initial episode, including pleuritic chest pain, diffuse ST-segment elevations, a pericardial friction rub, and elevated serum markers of inflammation.
- In the absence of prospective trial evidence, aspirin or another NSAID should form the foundation of therapy for recurrences (Table).
- However, in contrast to the brief course of NSAID generally prescribed for an initial episode, a gradual tapering of the drug over 2 to 4 weeks after symptoms improve is recommended.
- For recurrent episodes of pericarditis, treatment with an NSAID plus colchicine is recommended, but for a more prolonged course.
- During NSAID treatment, concurrent gastric protection therapy should be considered.
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