The goal of acute pericarditis therapy is to identify and treat the underlying disorder. Medication regimen may include antibiotics, NSAIDs, and corticosteroids. Assessing the patient's pain and ECG readings will help differentiate pericarditis from myocardial ischemia.
Antibiotics are used to treat bacterial pericarditis.
The administration of colchicine and NSAIDs are used to help control the pain and inflammation related to acute pericarditis (refer to the Picmonic on "Ibuprofen (NSAIDs)"). An exception, however, is cases of pericarditis secondary to myocardial infarction, where only aspirin should be used. This is because aspirin is less likely to affect scar formation in the heart than are other NSAIDs. Since NSAIDs may cause gastrointestinal irritation, administer these drugs with food or milk.
Since corticosteroids have various side effects, they are used selectively in patients with acute pericarditis. Corticosteroids are typically prescribed for patients with underlying rheumatologic or other autoimmune conditions already taking the medication. Corticosteroids may also be administered to relieve inflammation in patients who do not respond to NSAIDs.
Placing the patient in an upright position with the head of the bed elevated at 45 degrees may help provide pain relief. Bed rest may also help relieve pain in patients with acute pericarditis.
Pericardiocentesis is performed on patients with pericardial effusion, which can occur in pericarditis as inflammation leads to fluid extravasation into the pericardial space. Pericardial effusions can progress to cardiac tamponade or become infected in purulent pericarditis. A pericardiocentesis is a surgical procedure which can relieve cardiac pressure by inserting a needle into the pericardial space to remove fluid. Complications may include dysrhythmias, further cardiac tamponade, pneumothorax, and myocardial laceration.
The patient with acute pericarditis may develop excess fluid in the pericardial space, leading to pericardial effusion and potentially cardiac tamponade. In severe cases, a surgical procedure can be performed where a "window" is cut through the pericardium to allow drainage of excess fluid from the pericardium to the peritoneum or chest area.
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