Acute pericarditis: Update on diagnosis and management

TY - JOUR

T1 - Acute pericarditis: Update on diagnosis and management

AU - Ismail, Tevfik Fehmi

PY - 2020/1

Y1 - 2020/1

N2 - Acute pericarditis accounts for ∼5% of presentations with acute chest pain. Tuberculosis is an important cause in the developing world, however, in the UK and other developed settings, most cases are idiopathic/viral in origin. Non-steroidal anti-inflammatory drugs (NSAIDs) remain the cornerstone of treatment. At least one in four patients are at risk of recurrence. The addition of 3 months of colchicine can more than halve the risk of this (number needed to treat = four). Low-dose steroids can be helpful second-line agents for managing recurrences as adjuncts to NSAIDs and colchicine but should not be used as first-line agents. For patients failing this approach and/or dependent on corticosteroids, the interleukin-1β antagonist anakinra is a promising option, and for the few patients who are refractory to medical therapy, surgical pericardiectomy can be considered. The long-term prognosis is good with <0.5% risk of constriction for patients with idiopathic acute pericarditis.

AB - Acute pericarditis accounts for ∼5% of presentations with acute chest pain. Tuberculosis is an important cause in the developing world, however, in the UK and other developed settings, most cases are idiopathic/viral in origin. Non-steroidal anti-inflammatory drugs (NSAIDs) remain the cornerstone of treatment. At least one in four patients are at risk of recurrence. The addition of 3 months of colchicine can more than halve the risk of this (number needed to treat = four). Low-dose steroids can be helpful second-line agents for managing recurrences as adjuncts to NSAIDs and colchicine but should not be used as first-line agents. For patients failing this approach and/or dependent on corticosteroids, the interleukin-1β antagonist anakinra is a promising option, and for the few patients who are refractory to medical therapy, surgical pericardiectomy can be considered. The long-term prognosis is good with <0.5% risk of constriction for patients with idiopathic acute pericarditis.

KW - Pericarditis

KW - chest pain

KW - colchicine

KW - constriction

KW - pericardiectomy

UR - http://www.scopus.com/inward/record.url?scp=85077942019&partnerID=8YFLogxK

U2 - 10.7861/clinmed.cme.20.1.4

DO - 10.7861/clinmed.cme.20.1.4

M3 - Review article

SN - 1470-2118

VL - 20

SP - 48

EP - 51

JO - Clinical medicine (London, England)

JF - Clinical medicine (London, England)

IS - 1

ER -