Pericarditis - Treating pericarditis

Pericarditis is usually treated with medication, although surgery is used in rare cases.

You will be assessed to see whether it's safe for you to be treated at home.

You will usually be admitted to hospital if:

• you have a high temperature (fever) of 38C (100.4F) or above
• you have a high number of white blood cells – this could be the result of a serious infection
• your symptoms develop after a sudden injury to your chest
• you take blood-thinning medication (anticoagulants)
• blood tests show you have high levels of a type of protein called troponin in your blood (this can be the result of damage to the heart muscle)
• there is a risk of you developing cardiac tamponade, a serious complication of pericarditis caused by a build-up of fluid around the heart

You may also be admitted to hospital if treatment doesn't work.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Most cases of pericarditis can be successfully treated with non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs work by reducing the inflammation of the pericardium, and also relieve the chest pain.

Ibuprofen is the preferred choice of NSAID. The exception is if you've recently had a heart attack, as ibuprofen can interfere with the healing of your heart. In such circumstances, high-dose aspirin will usually be recommended.

As NSAIDs can occasionally cause stomach ulcers, you will probably be prescribed an additional medication called a proton pump inhibitor that provides protection against stomach ulcers.

Colchicine

Colchicine is a medicine that can be used on its own or in combination with NSAIDs.

It's often used if your symptoms fail to respond to NSAIDs or you are unable to take NSAIDs because of a pre-existing medical condition. 

Colchicine is useful because it can reduce inflammation of the pericardium by killing certain cells.

Side effects of colchicine include:

• abdominal pain
• vomiting
• diarrhoea

These side effects usually improve once your body gets used to the medication.

Colchicine does not currently have a licence to be used to treat pericarditis in the UK, which means it has not undergone clinical trials for this condition. However, studies have shown that colchicine can be effective in treating pericarditis, so you may still be prescribed it if the benefits outweigh any potential risks.

Corticosteroids

Corticosteroids are usually only given when the symptoms of pericarditis fail to respond to NSAIDs and colchicine, or there is a build-up of fluid inside the pericardium, which could put the heart at risk.

Corticosteroids block the effects of the immune system, leading to a reduction in inflammation.

Corticosteroids are powerful medicines and can have a range of side effects, especially if used for a long period of time.

Side effects of corticosteroids include:

• weight gain
• mood swings
• increased sweating

Other treatments

Treatment for pericarditis is different if it's not caused by a viral infection. For example, if your pericarditis is caused by a bacterial infection, such as tuberculosis, antibiotics are used.

In some cases, the fluid that builds up around the heart may be drained with a needle during a procedure called pericardiocentesis. However, this is usually only used if you develop complications of pericarditis.

Recurring pericarditis

NSAIDs can be used to relieve symptoms of an episode of pericarditis, while a long-term course of colchicine has proved effective in preventing symptoms returning.

If symptoms persist, then a short-course of steroid medication may be recommended.

If your symptoms are particularly severe and not responding to medication, a type of surgery known as pericardiectomy may be recommended.

This involves the surgeon making a large incision in your chest and removing some or all of your pericardium.

A pericardiectomy is usually regarded as a last resort, as the surgery is relatively risky – there is an estimated 1 in 20 chance of it causing death.