Nonsteroidal anti-inflammatory drugs
Because pericarditis is primarily due to inflammation, anti-inflammatory medications are considered the drugs of choice. These agents are effective for chest discomfort and underlying inflammation. However, although nonsteroidal-anti-inflammatory drugs (NSAIDs) may offer symptomatic relief, they are ineffective in uremic pericarditis absence of dialysis.
Indomethacin (Indocin)
Indomethacin is the classic treatment used in pericarditis and is often considered the first choice. This drug is rapidly absorbed, and it is metabolized in the liver by demethylation, deacetylation, and glucuronide conjugation. Although, indomethacin ameliorates fever, it does not accelerate resolution of effusion.
Ketorolac
Ketorolac is used for the relief of mild to moderate pain and inflammation. This agent inhibits prostaglandin synthesis by decreasing the activity of the enzyme cyclooxygenase, which results in decreased formation of prostaglandin precursors.
Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Small studies have documented rapid relief of symptoms with 1-2 doses of ketorolac. Doses of more than 75 mg do not increase therapeutic effects; therefore, administer high doses with caution, and closely observe patient response.
Ibuprofen (Motrin, Advil)
Ibuprofen is usually the drug of choice for mild to moderate pain, if no contraindications exist. This drug inhibits inflammatory reactions and pain, probably by decreasing the activity of the enzyme cyclooxygenase, which results in decreased prostaglandin synthesis.
Ketoprofen
Ketoprofen is used to relieve mild to moderate pain and inflammation. Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses of more than 75 mg do not increase therapeutic effects; therefore, administer high doses with caution, and closely observe patient response.
Naproxen (Anaprox, Naprelan, Naprosyn)
Naproxen is indicated for the relief of mild to moderate pain. This agent acts by inhibiting inflammatory reactions and pain via decreasing the activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.
-
Stage 1 electrocardiograph changes in a patient with acute pericarditis.
-
Stage 4 electrocardiograph changes in the same patient as in the previous image, taken approximately 3 months after acute pericardial illness. The patient remained symptom free despite continued T-wave inversion.
-
Chest radiographs revealing markedly enlarged cardiac silhouette and normal-appearing lung parenchyma in prepericardiocentesis (A) and postpericardiocentesis (B). Courtesy of Zhi Zhou, MD.
-
Recording of aortic pressure showing pulsus paradoxus. During inspiration, systolic pressure declines 20 mm Hg. Courtesy of Zhi Zhou, MD.
-
This ultrasonogram demonstrates a normal subcostal 4-chamber view of the heart. The pericardium is brightly reflective (echogenic or white in appearance). LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. Part B courtesy of Wikimedia Commons/Patrick J Lynch and C Carl Jaffe.
-
H&E stain, medium power magnification showing a rheumatoid nodule in rheumatoid pericarditis, composed of histiocytes and scattered multinucleated giant cells (lower right) surrounding necroinflammatory debris (upper left).
-
Pap stain, high power magnification of adenocarcinoma metastatic to the pericardium on pericardiocentesis with the red arrow showing a normal mesothelial cell and the black arrowhead showing adenocarcinoma.
