This protocol addresses recurrent pericarditis arising after an initial episode of acute pericarditis. One or more recurrences arise in 15% to 30% of patients following a first acute episode. 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.
This protocol applies when the preceding treatment line — which addressed pericarditis refractory to NSAID, colchicine, and glucocorticoid therapies, using agents such as azathioprine, methotrexate, intravenous immunoglobulin, or anakinra — did not achieve improvement of symptoms. Continuous relapsing despite those measures is the trigger for escalation to this step.
Symptomatic relief, with complete remission achievable in some patients. Results have been variable, with some patients experiencing complete remission but others continuing to be plagued with ongoing symptoms after surgical intervention.
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.
Finally, pericardiectomy can be undertaken for symptomatic relief in cases of continuously relapsing pericarditis.
The best outcomes have been reported when complete resection of the pericardium is undertaken.
Results have been variable, with some patients experiencing complete remission but others continuing to be plagued with ongoing symptoms after surgical intervention.
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