What are the 2015 ESC recommendations for the emergency care of pericarditis?

Updated: Apr 02, 2019
  • Author: Sean Spangler, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

The emergency care of the patient centers on prompt diagnosis and treatment of potentially life-threatening entities. Thoracotomy and pericardiotomy may be required if the patient has rapid deterioration or cardiac arrest.

For acute pericarditis, the 2015 European Society of Cardiology (ESC) update of their 2004 guidelines on the diagnosis and management of pericardial diseases recommends the following (all class I, level A evidence) [3, 4] :

  • Aspirin (750-1000 mg) or nonsteroidal anti-inflammatory drugs (NSAIDs) (ibuprofen 600 mg), every 8 hours for 1-2 weeks, with gastric protection
  • First-line therapy as adjunct to aspirin or NSAID therapy: Colchicine 0.5 mg daily (weight < 70 kg) or twice daily (weight ≥70 kg) for 3 months

Consider low-dose corticosteroids in cases of acute pericarditis when aspirin/NSAIDs and colchicine are contraindicated or have failed, and when an infectious cause has been excluded, or when there is a specific indication (eg, autoimmune disease) (class IIa, level C evidence). [3] However, corticosteroids are not recommended as first-line therapy for acute pericarditis (class III, level C evidence). [3]

In the setting of recurrent pericarditis, the ESC recommends administering aspirin or NSAIDs at full doses, if tolerated, until symptomatic relief, with the addition of 6 months of colchicine (0.5 mg twice daily or 0.5 mg daily for those < 70 kg or intolerant to higher doses) (both class I, level A evidence). [3, 4] In select cases, colchicine therapy longer than 6 months should be considered based on clinical response (class IIA, level C evidence). In cases of corticosteroid-dependent recurrent pericarditis refractory to colchicine, consider agents such as intravenous immunoglobulin (IVIG), anakinra, and azathioprine (class IIA, level C evidence).


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