Pericarditis treatment: Difference between revisions

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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Ventricular arrhythmias]] that develop in patients with pericardial disease should be treated in the same manner that such [[arrhythmias]] are treated in patients with other diseases including [[ICD]] and [[pacemaker]] implantation as required. Patients receiving ICD implantation should be receiving chronic optimal medical therapy and have reasonable expectation of survival with a good functional status for more than 1 year. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Ventricular arrhythmias]] that develop in [[Patient|patients]] with [[pericardial disease]] should be [[Therapy|treated]] in the same manner that such [[arrhythmias]] are [[Therapy|treated]] in [[Patient|patients]] with other [[diseases]] including [[ICD]] and [[pacemaker]] [[implantation]] as required. [[Patients]] receiving [[ICD]] [[implantation]] should be receiving [[Chronic (medicine)|chronic]] optimal [[medical]] [[therapy]] and have reasonable [[expectation]] of [[Survival rate|survival]] with a good functional status for more than 1 year. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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==2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)<ref name="AdlerCharron2015">{{cite journal|last1=Adler|first1=Yehuda|last2=Charron|first2=Philippe|last3=Imazio|first3=Massimo|last4=Badano|first4=Luigi|last5=Barón-Esquivias|first5=Gonzalo|last6=Bogaert|first6=Jan|last7=Brucato|first7=Antonio|last8=Gueret|first8=Pascal|last9=Klingel|first9=Karin|last10=Lionis|first10=Christos|last11=Maisch|first11=Bernhard|last12=Mayosi|first12=Bongani|last13=Pavie|first13=Alain|last14=Ristić|first14=Arsen D.|last15=Sabaté Tenas|first15=Manel|last16=Seferovic|first16=Petar|last17=Swedberg|first17=Karl|last18=Tomkowski|first18=Witold|title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases|journal=European Heart Journal|volume=36|issue=42|year=2015|pages=2921–2964|issn=0195-668X|doi=10.1093/eurheartj/ehv318}}</ref>==
==2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)<ref name="AdlerCharron2015">{{cite journal|last1=Adler|first1=Yehuda|last2=Charron|first2=Philippe|last3=Imazio|first3=Massimo|last4=Badano|first4=Luigi|last5=Barón-Esquivias|first5=Gonzalo|last6=Bogaert|first6=Jan|last7=Brucato|first7=Antonio|last8=Gueret|first8=Pascal|last9=Klingel|first9=Karin|last10=Lionis|first10=Christos|last11=Maisch|first11=Bernhard|last12=Mayosi|first12=Bongani|last13=Pavie|first13=Alain|last14=Ristić|first14=Arsen D.|last15=Sabaté Tenas|first15=Manel|last16=Seferovic|first16=Petar|last17=Swedberg|first17=Karl|last18=Tomkowski|first18=Witold|title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases|journal=European Heart Journal|volume=36|issue=42|year=2015|pages=2921–2964|issn=0195-668X|doi=10.1093/eurheartj/ehv318}}</ref>==
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| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' Hospital admission is recommended for high-risk patients with acute pericarditis (at least one risk factor).
| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' [[Hospital]] [[Admission note|admission]] is recommended for high-risk [[patients]] with [[acute pericarditis]] (at least one [[risk factor]]).
'''2.''' Outpatient management is recommended for low-risk patients with acute pericarditis.  
'''2.''' [[Outpatient]] management is recommended for low-risk [[patients]] with [[acute pericarditis]].  


'''3.''' Evaluation of response to anti-inflammatory therapy is recommended after 1 week.''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])<nowiki></nowiki><ref name="ImazioDemichelis2004">{{cite journal|last1=Imazio|first1=Massimo|last2=Demichelis|first2=Brunella|last3=Parrini|first3=Iris|last4=Giuggia|first4=Marco|last5=Cecchi|first5=Enrico|last6=Gaschino|first6=Gianni|last7=Demarie|first7=Daniela|last8=Ghisio|first8=Aldo|last9=Trinchero|first9=Rita|title=Day-hospital treatment of acute pericarditis|journal=Journal of the American College of Cardiology|volume=43|issue=6|year=2004|pages=1042–1046|issn=07351097|doi=10.1016/j.jacc.2003.09.055}}</ref><ref name="ImazioCecchi2007">{{cite journal|last1=Imazio|first1=Massimo|last2=Cecchi|first2=Enrico|last3=Demichelis|first3=Brunella|last4=Ierna|first4=Salvatore|last5=Demarie|first5=Daniela|last6=Ghisio|first6=Aldo|last7=Pomari|first7=Franco|last8=Coda|first8=Luisella|last9=Belli|first9=Riccardo|last10=Trinchero|first10=Rita|title=Indicators of Poor Prognosis of Acute Pericarditis|journal=Circulation|volume=115|issue=21|year=2007|pages=2739–2744|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.662114}}</ref>
'''3.''' Evaluation of response to [[Anti inflammatory medications|anti-inflammatory therapy]] is recommended after 1 week. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])<ref name="ImazioDemichelis2004">{{cite journal|last1=Imazio|first1=Massimo|last2=Demichelis|first2=Brunella|last3=Parrini|first3=Iris|last4=Giuggia|first4=Marco|last5=Cecchi|first5=Enrico|last6=Gaschino|first6=Gianni|last7=Demarie|first7=Daniela|last8=Ghisio|first8=Aldo|last9=Trinchero|first9=Rita|title=Day-hospital treatment of acute pericarditis|journal=Journal of the American College of Cardiology|volume=43|issue=6|year=2004|pages=1042–1046|issn=07351097|doi=10.1016/j.jacc.2003.09.055}}</ref><ref name="ImazioCecchi2007">{{cite journal|last1=Imazio|first1=Massimo|last2=Cecchi|first2=Enrico|last3=Demichelis|first3=Brunella|last4=Ierna|first4=Salvatore|last5=Demarie|first5=Daniela|last6=Ghisio|first6=Aldo|last7=Pomari|first7=Franco|last8=Coda|first8=Luisella|last9=Belli|first9=Riccardo|last10=Trinchero|first10=Rita|title=Indicators of Poor Prognosis of Acute Pericarditis|journal=Circulation|volume=115|issue=21|year=2007|pages=2739–2744|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.662114}}</ref>''
 
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| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki></nowiki>'''1.'''  Aspirin or NSAIDs are recommended as first-line therapy for acute pericarditis with gastroprotection.<ref name="LotrionteBiondi-Zoccai2010">{{cite journal|last1=Lotrionte|first1=Marzia|last2=Biondi-Zoccai|first2=Giuseppe|last3=Imazio|first3=Massimo|last4=Castagno|first4=Davide|last5=Moretti|first5=Claudio|last6=Abbate|first6=Antonio|last7=Agostoni|first7=Pierfrancesco|last8=Brucato|first8=Antonio L.|last9=Di Pasquale|first9=Pietro|last10=Raatikka|first10=Marja|last11=Sangiorgi|first11=Giuseppe|last12=Laudito|first12=Antonio|last13=Sheiban|first13=Imad|last14=Gaita|first14=Fiorenzo|title=International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences|journal=American Heart Journal|volume=160|issue=4|year=2010|pages=662–670|issn=00028703|doi=10.1016/j.ahj.2010.06.015}}</ref>
| bgcolor="LightGreen"|<nowiki></nowiki>'''1.'''  [[Aspirin]] or [[NSAIDs]] are recommended as [[first-line therapy]] for [[acute pericarditis]] with gastroprotection.<ref name="LotrionteBiondi-Zoccai2010">{{cite journal|last1=Lotrionte|first1=Marzia|last2=Biondi-Zoccai|first2=Giuseppe|last3=Imazio|first3=Massimo|last4=Castagno|first4=Davide|last5=Moretti|first5=Claudio|last6=Abbate|first6=Antonio|last7=Agostoni|first7=Pierfrancesco|last8=Brucato|first8=Antonio L.|last9=Di Pasquale|first9=Pietro|last10=Raatikka|first10=Marja|last11=Sangiorgi|first11=Giuseppe|last12=Laudito|first12=Antonio|last13=Sheiban|first13=Imad|last14=Gaita|first14=Fiorenzo|title=International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences|journal=American Heart Journal|volume=160|issue=4|year=2010|pages=662–670|issn=00028703|doi=10.1016/j.ahj.2010.06.015}}</ref>
'''2.''' Colchicine is recommended as first-line therapy for acute pericarditis as an adjunct to aspirin/NSAID therapy.''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])<nowiki></nowiki><ref name="ImazioBobbio2005">{{cite journal|last1=Imazio|first1=Massimo|last2=Bobbio|first2=Marco|last3=Cecchi|first3=Enrico|last4=Demarie|first4=Daniela|last5=Demichelis|first5=Brunella|last6=Pomari|first6=Franco|last7=Moratti|first7=Mauro|last8=Gaschino|first8=Gianni|last9=Giammaria|first9=Massimo|last10=Ghisio|first10=Aldo|last11=Belli|first11=Riccardo|last12=Trinchero|first12=Rita|title=Colchicine in Addition to Conventional Therapy for Acute Pericarditis|journal=Circulation|volume=112|issue=13|year=2005|pages=2012–2016|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.105.542738}}</ref><ref name="ImazioBrucato2013">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Cemin|first3=Roberto|last4=Ferrua|first4=Stefania|last5=Maggiolini|first5=Stefano|last6=Beqaraj|first6=Federico|last7=Demarie|first7=Daniela|last8=Forno|first8=Davide|last9=Ferro|first9=Silvia|last10=Maestroni|first10=Silvia|last11=Belli|first11=Riccardo|last12=Trinchero|first12=Rita|last13=Spodick|first13=David H.|last14=Adler|first14=Yehuda|title=A Randomized Trial of Colchicine for Acute Pericarditis|journal=New England Journal of Medicine|volume=369|issue=16|year=2013|pages=1522–1528|issn=0028-4793|doi=10.1056/NEJMoa1208536}}</ref><ref name="ImazioBrucato2014">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Belli|first3=Riccardo|last4=Forno|first4=Davide|last5=Ferro|first5=Silvia|last6=Trinchero|first6=Rita|last7=Adler|first7=Yehuda|title=Colchicine for the prevention of pericarditis|journal=Journal of Cardiovascular Medicine|volume=15|issue=12|year=2014|pages=840–846|issn=1558-2027|doi=10.2459/JCM.0000000000000103}}</ref><ref name="AlabedCabello2014">{{cite journal|last1=Alabed|first1=Samer|last2=Cabello|first2=Juan B|last3=Irving|first3=Greg J|last4=Qintar|first4=Mohammed|last5=Burls|first5=Amanda|title=Colchicine for pericarditis|journal=Cochrane Database of Systematic Reviews|year=2014|issn=14651858|doi=10.1002/14651858.CD010652.pub2}}</ref>
'''2.''' [[Colchicine]] is recommended as [[first-line therapy]] for [[acute pericarditis]] as an adjunct to [[aspirin]]/[[NSAIDs|NSAID]] [[therapy]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])<ref name="ImazioBobbio2005">{{cite journal|last1=Imazio|first1=Massimo|last2=Bobbio|first2=Marco|last3=Cecchi|first3=Enrico|last4=Demarie|first4=Daniela|last5=Demichelis|first5=Brunella|last6=Pomari|first6=Franco|last7=Moratti|first7=Mauro|last8=Gaschino|first8=Gianni|last9=Giammaria|first9=Massimo|last10=Ghisio|first10=Aldo|last11=Belli|first11=Riccardo|last12=Trinchero|first12=Rita|title=Colchicine in Addition to Conventional Therapy for Acute Pericarditis|journal=Circulation|volume=112|issue=13|year=2005|pages=2012–2016|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.105.542738}}</ref><ref name="ImazioBrucato2013">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Cemin|first3=Roberto|last4=Ferrua|first4=Stefania|last5=Maggiolini|first5=Stefano|last6=Beqaraj|first6=Federico|last7=Demarie|first7=Daniela|last8=Forno|first8=Davide|last9=Ferro|first9=Silvia|last10=Maestroni|first10=Silvia|last11=Belli|first11=Riccardo|last12=Trinchero|first12=Rita|last13=Spodick|first13=David H.|last14=Adler|first14=Yehuda|title=A Randomized Trial of Colchicine for Acute Pericarditis|journal=New England Journal of Medicine|volume=369|issue=16|year=2013|pages=1522–1528|issn=0028-4793|doi=10.1056/NEJMoa1208536}}</ref><ref name="ImazioBrucato2014">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Belli|first3=Riccardo|last4=Forno|first4=Davide|last5=Ferro|first5=Silvia|last6=Trinchero|first6=Rita|last7=Adler|first7=Yehuda|title=Colchicine for the prevention of pericarditis|journal=Journal of Cardiovascular Medicine|volume=15|issue=12|year=2014|pages=840–846|issn=1558-2027|doi=10.2459/JCM.0000000000000103}}</ref><ref name="AlabedCabello2014">{{cite journal|last1=Alabed|first1=Samer|last2=Cabello|first2=Juan B|last3=Irving|first3=Greg J|last4=Qintar|first4=Mohammed|last5=Burls|first5=Amanda|title=Colchicine for pericarditis|journal=Cochrane Database of Systematic Reviews|year=2014|issn=14651858|doi=10.1002/14651858.CD010652.pub2}}</ref>''
 
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'''2.''' Colchicine (0.5 mg twice daily or 0.5 mg daily for patients ,70 kg or intolerant to higher doses); use for 6 months is recommended as an adjunct to aspirin/
'''2.''' Colchicine (0.5 mg twice daily or 0.5 mg daily for patients ,70 kg or intolerant to higher doses); use for 6 months is recommended as an adjunct to aspirin/
NSAIDs.''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])<nowiki></nowiki><ref name="Imazio2011">{{cite journal|last1=Imazio|first1=Massimo|title=Colchicine for Recurrent Pericarditis (CORP)|journal=Annals of Internal Medicine|volume=155|issue=7|year=2011|pages=409|issn=0003-4819|doi=10.7326/0003-4819-155-7-201110040-00359}}</ref><ref name="ImazioBelli2014">{{cite journal|last1=Imazio|first1=Massimo|last2=Belli|first2=Riccardo|last3=Brucato|first3=Antonio|last4=Cemin|first4=Roberto|last5=Ferrua|first5=Stefania|last6=Beqaraj|first6=Federico|last7=Demarie|first7=Daniela|last8=Ferro|first8=Silvia|last9=Forno|first9=Davide|last10=Maestroni|first10=Silvia|last11=Cumetti|first11=Davide|last12=Varbella|first12=Ferdinando|last13=Trinchero|first13=Rita|last14=Spodick|first14=David H|last15=Adler|first15=Yehuda|title=Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial|journal=The Lancet|volume=383|issue=9936|year=2014|pages=2232–2237|issn=01406736|doi=10.1016/S0140-6736(13)62709-9}}</ref><ref name="ImazioBobbio2005">{{cite journal|last1=Imazio|first1=Massimo|last2=Bobbio|first2=Marco|last3=Cecchi|first3=Enrico|last4=Demarie|first4=Daniela|last5=Pomari|first5=Franco|last6=Moratti|first6=Mauro|last7=Ghisio|first7=Aldo|last8=Belli|first8=Riccardo|last9=Trinchero|first9=Rita|title=Colchicine as First-Choice Therapy for Recurrent Pericarditis|journal=Archives of Internal Medicine|volume=165|issue=17|year=2005|pages=1987|issn=0003-9926|doi=10.1001/archinte.165.17.1987}}</ref><ref name="ImazioBrucato2014">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Belli|first3=Riccardo|last4=Forno|first4=Davide|last5=Ferro|first5=Silvia|last6=Trinchero|first6=Rita|last7=Adler|first7=Yehuda|title=Colchicine for the prevention of pericarditis|journal=Journal of Cardiovascular Medicine|volume=15|issue=12|year=2014|pages=840–846|issn=1558-2027|doi=10.2459/JCM.0000000000000103}}</ref><ref name="AlabedCabello2014">{{cite journal|last1=Alabed|first1=Samer|last2=Cabello|first2=Juan B|last3=Irving|first3=Greg J|last4=Qintar|first4=Mohammed|last5=Burls|first5=Amanda|title=Colchicine for pericarditis|journal=Cochrane Database of Systematic Reviews|year=2014|issn=14651858|doi=10.1002/14651858.CD010652.pub2}}</ref>
NSAIDs.''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: A]])<nowiki/><ref name="Imazio2011">{{cite journal|last1=Imazio|first1=Massimo|title=Colchicine for Recurrent Pericarditis (CORP)|journal=Annals of Internal Medicine|volume=155|issue=7|year=2011|pages=409|issn=0003-4819|doi=10.7326/0003-4819-155-7-201110040-00359}}</ref><ref name="ImazioBelli2014">{{cite journal|last1=Imazio|first1=Massimo|last2=Belli|first2=Riccardo|last3=Brucato|first3=Antonio|last4=Cemin|first4=Roberto|last5=Ferrua|first5=Stefania|last6=Beqaraj|first6=Federico|last7=Demarie|first7=Daniela|last8=Ferro|first8=Silvia|last9=Forno|first9=Davide|last10=Maestroni|first10=Silvia|last11=Cumetti|first11=Davide|last12=Varbella|first12=Ferdinando|last13=Trinchero|first13=Rita|last14=Spodick|first14=David H|last15=Adler|first15=Yehuda|title=Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial|journal=The Lancet|volume=383|issue=9936|year=2014|pages=2232–2237|issn=01406736|doi=10.1016/S0140-6736(13)62709-9}}</ref><ref name="ImazioBobbio2005">{{cite journal|last1=Imazio|first1=Massimo|last2=Bobbio|first2=Marco|last3=Cecchi|first3=Enrico|last4=Demarie|first4=Daniela|last5=Pomari|first5=Franco|last6=Moratti|first6=Mauro|last7=Ghisio|first7=Aldo|last8=Belli|first8=Riccardo|last9=Trinchero|first9=Rita|title=Colchicine as First-Choice Therapy for Recurrent Pericarditis|journal=Archives of Internal Medicine|volume=165|issue=17|year=2005|pages=1987|issn=0003-9926|doi=10.1001/archinte.165.17.1987}}</ref><ref name="ImazioBrucato2014">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Belli|first3=Riccardo|last4=Forno|first4=Davide|last5=Ferro|first5=Silvia|last6=Trinchero|first6=Rita|last7=Adler|first7=Yehuda|title=Colchicine for the prevention of pericarditis|journal=Journal of Cardiovascular Medicine|volume=15|issue=12|year=2014|pages=840–846|issn=1558-2027|doi=10.2459/JCM.0000000000000103}}</ref><ref name="AlabedCabello2014">{{cite journal|last1=Alabed|first1=Samer|last2=Cabello|first2=Juan B|last3=Irving|first3=Greg J|last4=Qintar|first4=Mohammed|last5=Burls|first5=Amanda|title=Colchicine for pericarditis|journal=Cochrane Database of Systematic Reviews|year=2014|issn=14651858|doi=10.1002/14651858.CD010652.pub2}}</ref>''
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| colspan="1" style="text-align:center; background:Orange"|[[ESC guidelines classification scheme#Classification of Recommendations|Class III]]
| colspan="1" style="text-align:center; background:Orange"|[[ESC guidelines classification scheme#Classification of Recommendations|Class III]]
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|bgcolor="Orange" |<nowiki></nowiki> Corticosteroid therapy is not recommended as a first line-approach.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki></nowiki><ref name="Imazio2011">{{cite journal|last1=Imazio|first1=Massimo|title=Colchicine for Recurrent Pericarditis (CORP)|journal=Annals of Internal Medicine|volume=155|issue=7|year=2011|pages=409|issn=0003-4819|doi=10.7326/0003-4819-155-7-201110040-00359}}</ref><ref name="ImazioBelli2014">{{cite journal|last1=Imazio|first1=Massimo|last2=Belli|first2=Riccardo|last3=Brucato|first3=Antonio|last4=Cemin|first4=Roberto|last5=Ferrua|first5=Stefania|last6=Beqaraj|first6=Federico|last7=Demarie|first7=Daniela|last8=Ferro|first8=Silvia|last9=Forno|first9=Davide|last10=Maestroni|first10=Silvia|last11=Cumetti|first11=Davide|last12=Varbella|first12=Ferdinando|last13=Trinchero|first13=Rita|last14=Spodick|first14=David H|last15=Adler|first15=Yehuda|title=Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial|journal=The Lancet|volume=383|issue=9936|year=2014|pages=2232–2237|issn=01406736|doi=10.1016/S0140-6736(13)62709-9}}</ref><ref name="ImazioBobbio2005">{{cite journal|last1=Imazio|first1=Massimo|last2=Bobbio|first2=Marco|last3=Cecchi|first3=Enrico|last4=Demarie|first4=Daniela|last5=Pomari|first5=Franco|last6=Moratti|first6=Mauro|last7=Ghisio|first7=Aldo|last8=Belli|first8=Riccardo|last9=Trinchero|first9=Rita|title=Colchicine as First-Choice Therapy for Recurrent Pericarditis|journal=Archives of Internal Medicine|volume=165|issue=17|year=2005|pages=1987|issn=0003-9926|doi=10.1001/archinte.165.17.1987}}</ref><ref name="LotrionteBiondi-Zoccai2010">{{cite journal|last1=Lotrionte|first1=Marzia|last2=Biondi-Zoccai|first2=Giuseppe|last3=Imazio|first3=Massimo|last4=Castagno|first4=Davide|last5=Moretti|first5=Claudio|last6=Abbate|first6=Antonio|last7=Agostoni|first7=Pierfrancesco|last8=Brucato|first8=Antonio L.|last9=Di Pasquale|first9=Pietro|last10=Raatikka|first10=Marja|last11=Sangiorgi|first11=Giuseppe|last12=Laudito|first12=Antonio|last13=Sheiban|first13=Imad|last14=Gaita|first14=Fiorenzo|title=International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences|journal=American Heart Journal|volume=160|issue=4|year=2010|pages=662–670|issn=00028703|doi=10.1016/j.ahj.2010.06.015}}</ref><ref name="ImazioBrucato2008">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Cumetti|first3=Davide|last4=Brambilla|first4=Giovanni|last5=Demichelis|first5=Brunella|last6=Ferro|first6=Silvia|last7=Maestroni|first7=Silvia|last8=Cecchi|first8=Enrico|last9=Belli|first9=Riccardo|last10=Palmieri|first10=Giancarlo|last11=Trinchero|first11=Rita|title=Corticosteroids for Recurrent Pericarditis|journal=Circulation|volume=118|issue=6|year=2008|pages=667–671|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.107.761064}}</ref><ref name="ImazioBrucato2007">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Adler|first3=Yehuda|last4=Brambilla|first4=Giovanni|last5=Artom|first5=Galit|last6=Cecchi|first6=Enrico|last7=Palmieri|first7=Giancarlo|last8=Trinchero|first8=Rita|title=Prognosis of Idiopathic Recurrent Pericarditis as Determined from Previously Published Reports|journal=The American Journal of Cardiology|volume=100|issue=6|year=2007|pages=1026–1028|issn=00029149|doi=10.1016/j.amjcard.2007.04.047}}</ref>
|bgcolor="Orange" |<nowiki></nowiki> Corticosteroid therapy is not recommended as a first line-approach.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki></nowiki><ref name="Imazio2011">{{cite journal|last1=Imazio|first1=Massimo|title=Colchicine for Recurrent Pericarditis (CORP)|journal=Annals of Internal Medicine|volume=155|issue=7|year=2011|pages=409|issn=0003-4819|doi=10.7326/0003-4819-155-7-201110040-00359}}</ref><ref name="ImazioBelli2014">{{cite journal|last1=Imazio|first1=Massimo|last2=Belli|first2=Riccardo|last3=Brucato|first3=Antonio|last4=Cemin|first4=Roberto|last5=Ferrua|first5=Stefania|last6=Beqaraj|first6=Federico|last7=Demarie|first7=Daniela|last8=Ferro|first8=Silvia|last9=Forno|first9=Davide|last10=Maestroni|first10=Silvia|last11=Cumetti|first11=Davide|last12=Varbella|first12=Ferdinando|last13=Trinchero|first13=Rita|last14=Spodick|first14=David H|last15=Adler|first15=Yehuda|title=Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial|journal=The Lancet|volume=383|issue=9936|year=2014|pages=2232–2237|issn=01406736|doi=10.1016/S0140-6736(13)62709-9}}</ref><ref name="ImazioBobbio2005">{{cite journal|last1=Imazio|first1=Massimo|last2=Bobbio|first2=Marco|last3=Cecchi|first3=Enrico|last4=Demarie|first4=Daniela|last5=Pomari|first5=Franco|last6=Moratti|first6=Mauro|last7=Ghisio|first7=Aldo|last8=Belli|first8=Riccardo|last9=Trinchero|first9=Rita|title=Colchicine as First-Choice Therapy for Recurrent Pericarditis|journal=Archives of Internal Medicine|volume=165|issue=17|year=2005|pages=1987|issn=0003-9926|doi=10.1001/archinte.165.17.1987}}</ref><ref name="LotrionteBiondi-Zoccai2010">{{cite journal|last1=Lotrionte|first1=Marzia|last2=Biondi-Zoccai|first2=Giuseppe|last3=Imazio|first3=Massimo|last4=Castagno|first4=Davide|last5=Moretti|first5=Claudio|last6=Abbate|first6=Antonio|last7=Agostoni|first7=Pierfrancesco|last8=Brucato|first8=Antonio L.|last9=Di Pasquale|first9=Pietro|last10=Raatikka|first10=Marja|last11=Sangiorgi|first11=Giuseppe|last12=Laudito|first12=Antonio|last13=Sheiban|first13=Imad|last14=Gaita|first14=Fiorenzo|title=International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences|journal=American Heart Journal|volume=160|issue=4|year=2010|pages=662–670|issn=00028703|doi=10.1016/j.ahj.2010.06.015}}</ref><ref name="ImazioBrucato2008">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Cumetti|first3=Davide|last4=Brambilla|first4=Giovanni|last5=Demichelis|first5=Brunella|last6=Ferro|first6=Silvia|last7=Maestroni|first7=Silvia|last8=Cecchi|first8=Enrico|last9=Belli|first9=Riccardo|last10=Palmieri|first10=Giancarlo|last11=Trinchero|first11=Rita|title=Corticosteroids for Recurrent Pericarditis|journal=Circulation|volume=118|issue=6|year=2008|pages=667–671|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.107.761064}}</ref><ref name="ImazioBrucato2007">{{cite journal|last1=Imazio|first1=Massimo|last2=Brucato|first2=Antonio|last3=Adler|first3=Yehuda|last4=Brambilla|first4=Giovanni|last5=Artom|first5=Galit|last6=Cecchi|first6=Enrico|last7=Palmieri|first7=Giancarlo|last8=Trinchero|first8=Rita|title=Prognosis of Idiopathic Recurrent Pericarditis as Determined from Previously Published Reports|journal=The American Journal of Cardiology|volume=100|issue=6|year=2007|pages=1026–1028|issn=00029149|doi=10.1016/j.amjcard.2007.04.047}}</ref>''
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon" |<nowiki></nowiki>'''1.''' Pericardiectomy should be considered for radiation-induced constrictive pericarditis, but with a worse outcome than when performed for constrictive pericarditis of other causes, because of co-existing myopathy.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki></nowiki><ref name="BertogThambidorai2004">{{cite journal|last1=Bertog|first1=Stefan C.|last2=Thambidorai|first2=Senthil K.|last3=Parakh|first3=Kapil|last4=Schoenhagen|first4=Paul|last5=Ozduran|first5=Volkan|last6=Houghtaling|first6=Penny L.|last7=Lytle|first7=Bruce W.|last8=Blackstone|first8=Eugene H.|last9=Lauer|first9=Michael S.|last10=Klein|first10=Allan L.|title=Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy|journal=Journal of the American College of Cardiology|volume=43|issue=8|year=2004|pages=1445–1452|issn=07351097|doi=10.1016/j.jacc.2003.11.048}}</ref><ref name="DeValeriaBaumgartner1991">{{cite journal|last1=DeValeria|first1=Patrick A.|last2=Baumgartner|first2=William A.|last3=Casale|first3=Alfred S.|last4=Greene|first4=Peter S.|last5=Cameron|first5=Duke E.|last6=Gardner|first6=Timothy J.|last7=Gott|first7=Vincent L.|last8=Watkins|first8=Levi|last9=Reitz|first9=Bruce A.|title=Current indications, risks, and outcome after pericardiectomy|journal=The Annals of Thoracic Surgery|volume=52|issue=2|year=1991|pages=219–224|issn=00034975|doi=10.1016/0003-4975(91)91339-W}}</ref><ref name="KomodaFrumkin2013">{{cite journal|last1=Komoda|first1=Takeshi|last2=Frumkin|first2=Alexander|last3=Knosalla|first3=Christoph|last4=Hetzer|first4=Roland|title=Child-Pugh Score Predicts Survival After Radical Pericardiectomy for Constrictive Pericarditis|journal=The Annals of Thoracic Surgery|volume=96|issue=5|year=2013|pages=1679–1685|issn=00034975|doi=10.1016/j.athoracsur.2013.06.016}}</ref><ref name="LingOh1999">{{cite journal|last1=Ling|first1=Lieng H.|last2=Oh|first2=Jae K.|last3=Schaff|first3=Hartzell V.|last4=Danielson|first4=Gordon K.|last5=Mahoney|first5=Douglas W.|last6=Seward|first6=James B.|last7=Tajik|first7=A. Jamil|title=Constrictive Pericarditis in the Modern Era|journal=Circulation|volume=100|issue=13|year=1999|pages=1380–1386|issn=0009-7322|doi=10.1161/01.CIR.100.13.1380}}</ref>
|bgcolor="LemonChiffon" |<nowiki></nowiki>'''1.''' Pericardiectomy should be considered for radiation-induced constrictive pericarditis, but with a worse outcome than when performed for constrictive pericarditis of other causes, because of co-existing myopathy.''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])<nowiki></nowiki><ref name="BertogThambidorai2004">{{cite journal|last1=Bertog|first1=Stefan C.|last2=Thambidorai|first2=Senthil K.|last3=Parakh|first3=Kapil|last4=Schoenhagen|first4=Paul|last5=Ozduran|first5=Volkan|last6=Houghtaling|first6=Penny L.|last7=Lytle|first7=Bruce W.|last8=Blackstone|first8=Eugene H.|last9=Lauer|first9=Michael S.|last10=Klein|first10=Allan L.|title=Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy|journal=Journal of the American College of Cardiology|volume=43|issue=8|year=2004|pages=1445–1452|issn=07351097|doi=10.1016/j.jacc.2003.11.048}}</ref><ref name="DeValeriaBaumgartner1991">{{cite journal|last1=DeValeria|first1=Patrick A.|last2=Baumgartner|first2=William A.|last3=Casale|first3=Alfred S.|last4=Greene|first4=Peter S.|last5=Cameron|first5=Duke E.|last6=Gardner|first6=Timothy J.|last7=Gott|first7=Vincent L.|last8=Watkins|first8=Levi|last9=Reitz|first9=Bruce A.|title=Current indications, risks, and outcome after pericardiectomy|journal=The Annals of Thoracic Surgery|volume=52|issue=2|year=1991|pages=219–224|issn=00034975|doi=10.1016/0003-4975(91)91339-W}}</ref><ref name="KomodaFrumkin2013">{{cite journal|last1=Komoda|first1=Takeshi|last2=Frumkin|first2=Alexander|last3=Knosalla|first3=Christoph|last4=Hetzer|first4=Roland|title=Child-Pugh Score Predicts Survival After Radical Pericardiectomy for Constrictive Pericarditis|journal=The Annals of Thoracic Surgery|volume=96|issue=5|year=2013|pages=1679–1685|issn=00034975|doi=10.1016/j.athoracsur.2013.06.016}}</ref><ref name="LingOh1999">{{cite journal|last1=Ling|first1=Lieng H.|last2=Oh|first2=Jae K.|last3=Schaff|first3=Hartzell V.|last4=Danielson|first4=Gordon K.|last5=Mahoney|first5=Douglas W.|last6=Seward|first6=James B.|last7=Tajik|first7=A. Jamil|title=Constrictive Pericarditis in the Modern Era|journal=Circulation|volume=100|issue=13|year=1999|pages=1380–1386|issn=0009-7322|doi=10.1161/01.CIR.100.13.1380}}</ref>''
|}
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Revision as of 21:16, 16 December 2019

Pericarditis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Ahmed Zaghw, M.D. [3] Homa Najafi, M.D.[4]

Overview

The management of pericarditis depends on whether the patient has an uncomplicated vs. complicated disease course. Uncomplicated pericarditis is generally treated with non-steroidal anti-inflammatory drugs, such as Ibuprofen in cases of either viral or idiopathic pericarditis, and Aspirin in cases of post-MI pericarditis. Pericarditis complicated with either effusion or cardiac tamponade is generally treated with urgent pericardiocentesis in the case of cardiac tamponade, antibiotics in the case of purulent pericardial effusion, and either steroids or colchicine among patients with recurrent or refractory disease.

Management of Uncomplicated Pericarditis

Patients with uncomplicated acute pericarditis can generally be treated and followed up in an outpatient clinic. The treatment of viral or idiopathic pericarditis is with non-steroidal anti-inflammatory drugs. Patients should be observed for side effects since NSAIDs are known to affect the GI mucosa. If the underlying cause of pericarditis is something other than a viral cause, the specific etiology should be treated.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Note: Patients with several risk factors are at the highest risk of NSAID-induced gastroduodenal toxicity.

Aspirin Therapy

An alternative therapy is aspirin 800 mg every 6-8 hours.[5]

Post-MI Pericarditis

In pericarditis following acute myocardial infarction, NSAIDs other than aspirin should be avoided since they can impair scar formation.

Failure to Respond to a Week of Traditional Therapy

Failure to respond to NSAIDs within one week (as indicated by persistence of fever, a worsening of symptoms such as chest pain, the development of a new pericardial effusion), likely indicates that the underlying cause may not be viral or idiopathic in nature. These patients may require re-evaluation, observation, and more aggressive therapy as described in the next section.

Colchicine

In the European guidelines, colchicine carries a class IIa recommendation for the treatment of an initial episode of pericarditis along with an NSAID. The dose is 0.6 mg bid for 3 months. It should be noted that a long term treatment of colchicine for several weeks or months should be considered, even after disappearance of effusion.[6] [7]

The rate of recurrence after an initial episode is lowered with colchicine therapy by approximately 50% - from 26% to 14% (see Forest plot).[8]

For example, in a multicenter, double-blind trial, the use of colchicine at a dose of 0.5 mg twice daily for 3 months for patients weighing >70 kg or 0.5 mg once daily for patients weighing ≤70 kg in acute pericarditis, when added to conventional antiinflammatory therapy with aspirin or ibuprofen, significantly reduced the rate of symptom persistence at 72 hours (19.2% vs. 40.0%, P=0.001), the number of recurrences per patient (0.21 vs. 0.52, P = 0.001), the hospitalization rate (5.0% vs. 14.2%, P = 0.02), and the remission rate at 1 week (85.0% vs. 58.3%, P<0.001), as compared with placebo.[9]

Steroids

Steroids are not used to treat an initial episode of pericarditis. They provide rapid relief in pain, but are associated with a high rate of recurrence.

Identification of High Risk or Complicated Pericarditis

Patients at high risk of developing complications of pericarditis may required admission to an inpatient service for careful observation for hemodynamic compromise. High risk patients include those with:[5]

Management of Complicated Pericarditis

Drainage in most of cases for culture and local antibiotics †
PLUS
Primary Systemic Regimens in Bacterial Pericarditis ‡
Vancomycin: 15-20 mg/kg q8-12h (target troughs of 15-20 μg/mL) x ???? wks
PLUS
Ceftriaxone: 2 gm IV q24h x ??? wks
or
Cefepime: 2 gm IV q12h x ??? wks
Alternative Systemic Regimens in Bacterial Pericarditis
Vancomycin: 15-20 mg/kg q8-12h (target troughs of 15-20 μg/mL) x ??? wks
PLUS
Ciprofloxacin: 750 mg po bid or 400 mg IV bid
† Immediate pericardial fluid removal for hemodynamic compromise
‡ Modify regimen and narrow coverage based on results of culture and susceptibility tests.
Mild Histoplasmosis Pericarditis
Ibuprofen: 300-800 mg q 6-8 hrs x 1-2 wks as needed, to be tapered †
OR
Indomethacin: 50 mg q8 hrs x 1-2 wks as needed, to be tapered
PLUS
Colchicine: 0.5 to 0.6 mg two times daily x 3 months
NSAID Non-Responders or Hemodynamic Compromise Histoplasmosis Pericarditis
Prednisone: 1 mg/kg po daily tapered over 1–2 wks
PLUS
Itraconazole: 200 mg po 3 times daily x 3 days, then twice daily x 6–12 wks)
PLUS
Pericardial fluid removal for hemodynamic compromise

Management of Cardiac Tamponade and Large Pericardial Effusion

Pericardiocentesis is an invasive procedure in which the pericardial fluid is drained through a needle. A pericardial window is a surgical procedure to drain fluid form the pericardium. Indications for a pericardiocentesis or a pericardial window include the following:[2]

Management of Recurrent Pericarditis

Bacterial Pericarditis

Antimicrobial Therapy

1. Bacterial Pericarditis

  • 1.1. Empiric antimicrobial therapy[16][17]
  • Preferred regimen: Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 28 days AND Ciprofloxacin 400 mg IV q12h for 28 days
  • Alternative regimen (1): Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 28 days AND Cefepime 2 g IV q12h for 28 days
  • Alternative regimen (2): Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 14–42 days AND Ceftriaxone 2 g IV q24h for 14–42 days
Note: Pericardiocentesis must be promptly performed. Pericardial drainage combined with effective systemic antibiotic therapy is mandatory (antistaphylococcal agent plus aminoglycoside, followed by tailored antibiotic therapy according to cultures). Frequent irrigation of the pericardial cavity with urokinase or streptokinase may be considered. Open surgical drainage through subxiphoid pericardiotomy is preferable. Pericardiectomy may be required in patients with dense adhesions, loculated and thick purulent effusion, recurrence of tamponade, persistent infection, and progression to constriction.
  • 1.2.1. Purulent pericarditis with contiguous pneumonia
  • 1.2.2. Purulent pericarditis with contiguous head and neck infection
  • 1.2.3. Purulent pericarditis secondary to infective endocarditis
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h targeting trough levels of 15–20 μg/mL AND Gentamicin 3 mg/kg/day IV q8–12h
  • 1.2.4. Purulent pericarditis after cardiac surgery, pediatric
  • 1.2.5. Purulent pericarditis with genitourinary infection, pediatric
  • 1.2.6. Purulent pericarditis in immunocompromised host, pediatric
  • 1.3. Pathogen-directed antimicrobial therapy[22]
  • 1.3.1. Anaerobes
  • 1.3.2. Gram-negative bacilli
  • 1.3.3. Legionella pneumophila
  • 1.3.4. Mycoplasma pneumoniae
  • 1.3.5. Neisseria meningitidis
  • 1.3.6. Staphylococcus aureus, methicillin-susceptible
  • 1.3.7. Staphylococcus aureus, methicillin-resistant
  • Preferred regimen: Vancomycin 1 g IV q12h targeting trough levels of 15–20 μg/mL for 14–42 days OR Linezolid 600 mg IV q12h for 14–42 days
  • 1.3.8. Streptococcus pneumoniae, penicillin-susceptible
  • 1.3.9. Streptococcus pneumoniae, penicillin-resistant

2. Tuberculous Pericarditis[23].

3. Viral pericarditis[23]

  • 3.1. CMV pericarditis
  • Preferred regimen: Immunoglobulin 1 time per day 4 ml/kg on day 0, 4, and 8; 2 ml/kg on day 12 and 16.
Note: Symptomatic treatment is given to the patients with viral pericarditis while in large effusions and cardiac tamponade pericardiocentesis is necessary. The use of corticosteroid therapy is contraindicated except in patients with secondary tuberculous pericarditis, as an adjunct to tuberculosis treatment. Drainage, if needed is done.
  • 3.2. Coxsackie B pericarditis
Note: Symptomatic treatment is given to the patients with viral pericarditis while in large effusions and cardiac tamponade pericardiocentesis is necessary. The use of corticosteroid therapy is contraindicated except in patients with secondary tuberculous pericarditis, as an adjunct to tuberculosis treatment. Drainage, if needed is done.
  • 3.3. Adenovirus and parvovirus B19 perimyocarditis
Note: Symptomatic treatment is given to the patients with viral pericarditis while in large effusions and cardiac tamponade pericardiocentesis is necessary. The use of corticosteroid therapy is contraindicated except in patients with secondary tuberculous pericarditis, as an adjunct to tuberculosis treatment. Drainage, if needed is done.

4. Fungal Pericarditis[23]

  • 4.1. Histoplasmosis
Note: Corticosteroids and NSAIDs can support the treatment with antifungal drugs. Pericardiocentesis or surgical treatment is indicated for haemodynamic impairment. Pericardiectomy is indicated in fungal constrictive pericarditis.
  • 4.2. Nocardiosis
Note: Corticosteroids and NSAIDs can support the treatment with antifungal drugs. Pericardiocentesis or surgical treatment is indicated for haemodynamic impairment. Pericardiectomy is indicated in fungal constrictive pericarditis.
  • 4.3. Actinomycosis
Note: Corticosteroids and NSAIDs can support the treatment with antifungal drugs. Pericardiocentesis or surgical treatment is indicated for haemodynamic impairment. Pericardiectomy is indicated in fungal constrictive pericarditis.

2006 ACC/AHA/ESC Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT)[25]

Pericardial Diseases (DO NOT EDIT)[25]

Class I
"1. Ventricular arrhythmias that develop in patients with pericardial disease should be treated in the same manner that such arrhythmias are treated in patients with other diseases including ICD and pacemaker implantation as required. Patients receiving ICD implantation should be receiving chronic optimal medical therapy and have reasonable expectation of survival with a good functional status for more than 1 year. (Level of Evidence: C)"

2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)[26]

Recommendations for the management of acute pericarditis

Class I
1. Hospital admission is recommended for high-risk patients with acute pericarditis (at least one risk factor).

2. Outpatient management is recommended for low-risk patients with acute pericarditis.

3. Evaluation of response to anti-inflammatory therapy is recommended after 1 week. (Level of Evidence: B)[27][28]

Recommendations for the treatment of acute pericarditis

Class I
1. Aspirin or NSAIDs are recommended as first-line therapy for acute pericarditis with gastroprotection.[29]

2. Colchicine is recommended as first-line therapy for acute pericarditis as an adjunct to aspirin/NSAID therapy. (Level of Evidence: A)[30][31][32][33]

Class IIa
1. Serum CRP should be considered to guide the treatment length and assess the response to therapy.

2. Low-dose corticosteroids should be considered for acute pericarditis in cases of contraindication/failure of aspirin/NSAIDs and colchicine, and when an infectious cause has been excluded, or when there is a specific indication such as autoimmune disease.

3. Exercise restriction should be considered for non-athletes with acute pericarditis until resolution of symptoms and normalization of CRP, ECG and echocardiogram.

4. For athletes, the duration of exercise restriction should be considered until resolution of symptoms and normalization of CRP, ECG and echocardiogram—at least 3 months is recommended(Level of Evidence: C)

Class III
Corticosteroids are not recommendedas first-line therapy for acute pericarditis.(Level of Evidence: C)

Recommendations for the management of recurrent pericarditis

Class I
1. Aspirin and NSAIDs are mainstays of treatment and are recommended at full doses, if tolerated, until complete symptom resolution.[29][32]

2. Colchicine (0.5 mg twice daily or 0.5 mg daily for patients ,70 kg or intolerant to higher doses); use for 6 months is recommended as an adjunct to aspirin/ NSAIDs.(Level of Evidence: A)[34][35][30][32][33]

Class IIa
1. Colchicine therapy of longer duration (>6 months) should be considered in some cases, according to clinical

response.

2. CRP dosage should be considered to guide the treatment duration and assess the response to therapy.

3. After CRP normalization, a gradual tapering of therapies should be considered, tailored to symptoms and CRP, stopping a single class of drugs at a time.

4. Drugs such as IVIG, anakinra and azathioprine may be considered in cases of corticosteroid-dependent recurrent pericarditis in patients not responsive to colchicine.

5. Exercise restriction should be considered for non-athletes with recurrent pericarditis until symptom resolution and CRP normalization, taking into account the previous history and clinical conditions.

6. Exercise restriction for a minimum of 3 months should be considered for athletes with recurrent pericarditis until symptom resolution and normalization of CRP, ECG and echocardiogram.

7. If ischaemic heart disease is a concern or antiplatelet therapy is required, aspirin should be considered, at medium-high doses (1–2.4 g/day).

8. If symptoms recur during therapy tapering, the management should consider not increasing the dose of corticosteroids to control symptoms, but increasing to the maximum dose of aspirin or NSAIDs, well distributed, generally every 8 hours, and intravenously if necessary, adding colchicine and adding analgesics for pain control.(Level of Evidence: C)

Class III
Corticosteroid therapy is not recommended as a first line-approach.(Level of Evidence: B)[34][35][30][29][36][37]

Recommendations for the diagnosis of constrictive pericarditis

Class I
1. Transthoracic echocardiography is recommended in all patients with suspected constrictive pericarditis.

2. Chest X-ray (frontal and lateral views)with adequate technical characteristics is recommended in all patients with suspected constrictive pericarditis.

3. CT and/or CMR are indicated as second-level imaging techniques to assess calcifications (CT), pericardial thickness, degree and extension of pericardial involvement.

4.Cardiac catheterization is indicated when non-invasive diagnostic methods do not provide a definite diagnosis of constriction.(Level of Evidence: C)

Recommendations for therapy of constrictive pericarditis

Class I
1. The mainstay of treatment of chronic permanent constriction is pericardiectomy.

2. Medical therapy of specific pericarditis (i.e.tuberculous pericarditis) is recommended to prevent the progression of constriction.(Level of Evidence: C)

Class IIb
Empiric anti-inflammatory therapy may be considered in cases with transient or new diagnosis of constriction with concomitant evidence of pericardial inflammation (i.e. CRP elevation or pericardial enhancement on CT/CMR).(Level of Evidence: C)

Recommendations for the diagnosis and therapy of viral pericarditis

Class IIa
For the definited diagnosis of viral pericarditis, a comprehensive workup of histological, cytological, immunohistological and molecular investigations in pericardial fluid and peri-/epicardial biopsies should be considered.(Level of Evidence: C)
Class III
1. Routine viral serology is not recommended, with the possible exception of HIV and HCV.

2. Corticosteroid therapy is not recommended in viral pericarditis. (Level of Evidence: C)

Recommendations for the therapy of purulent pericarditis

Class I
1. Effective pericardial drainage is recommended for purulent pericarditis.

2. Administration of intravenous antibiotics is indicated to treat purulent pericarditis.(Level of Evidence: C)

Class IIa
1. Subxiphoid pericardiotomy and rinsing of the pericardial cavity should be considered.

2. Intrapericardial thrombolysis should be considered.

3. Pericardiectomy for dense adhesions, loculated or thick purulent effusion, recurrence of tamponade, persistent infection and progression to constriction should be considered.(Level of Evidence: C)

Recommendations for the management of pericarditis in renal failure

Class IIa
1. Dialysis should be considered in uraemic pericarditis.

2. When patients with adequate dialysis develop pericarditis, intensifying dialysis should be considered.(Level of Evidence: C)

Class IIb
1. Pericardial aspiration and/or drainage may be considered in non-responsive patients with dialysis.

2. NSAIDs and corticosteroids (systemic or intrapericardial) may be considered when intensive dialysis is ineffective.(Level of Evidence: C)

Class III
Colchicine is contraindicated in patients with pericarditis and severe renal impairment.(Level of Evidence: C)

Recommendations for the prevention and management of radiation pericarditis

Class I
1. Radiation therapy methods that reduce both the volume and the dose of cardiac irradiation are recommended whenever

possible.(Level of Evidence: C)

Class IIa
1. Pericardiectomy should be considered for radiation-induced constrictive pericarditis, but with a worse outcome than when performed for constrictive pericarditis of other causes, because of co-existing myopathy.(Level of Evidence: B)[38][39][40][41]

Recommendations for therapy of acute and recurrent pericarditis in children

Class I
1. NSAIDs at high doses are recommended as first-line therapy for acute pericarditis in children until complete symptom

resolution.(Level of Evidence: C)

Class IIa
Colchicine should be considered as an adjunct to anti-inflammatory therapy for acute recurrent pericarditis in children:

<5 years, 0.5 mg/day; >5 years, 1.0–1.5 mg/day in two to three divided doses.(Level of Evidence: C)

Class IIb
Anti-IL-1 drugs may be considered in children with recurrent pericarditis and especially when they are corticosteroid

dependen.(Level of Evidence: C)

Class III
1. Aspirin is not recommended in children due to the associated risk of Reye’s syndrome and hepatotoxicity.

2. Corticosteroids are not recommended due to the severity of their side effects in growing children unless there are specific indications such as autoimmune diseases(Level of Evidence: C)

References

  1. Gabriel, SE.; Jaakkimainen, L.; Bombardier, C. (1991). "Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis". Ann Intern Med. 115 (10): 787–96. PMID 1834002. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH (2004). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology". Eur Heart J. 25 (7): 587–10. doi:10.1016/j.ehj.2004.02.002. PMID 15120056.
  3. Imazio, M.; Demichelis, B.; Parrini, I.; Giuggia, M.; Cecchi, E.; Gaschino, G.; Demarie, D.; Ghisio, A.; Trinchero, R. (2004). "Day-hospital treatment of acute pericarditis: a management program for outpatient therapy". J Am Coll Cardiol. 43 (6): 1042–6. doi:10.1016/j.jacc.2003.09.055. PMID 15028364. Unknown parameter |month= ignored (help)
  4. Lanza, FL. (1998). "A guideline for the treatment and prevention of NSAID-induced ulcers. Members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology". Am J Gastroenterol. 93 (11): 2037–46. doi:10.1111/j.1572-0241.1998.00588.x. PMID 9820370. Unknown parameter |month= ignored (help)
  5. 5.0 5.1 Imazio M, Demichelis B, Parrini I, Giuggia M, Cecchi E, Gaschino G, Demarie D, Ghisio A, Trinchero R (2004). "Day-hospital treatment of acute pericarditis: a management program for outpatient therapy". J Am Coll Cardiol. 43 (6): 1042–6. doi:10.1016/j.jacc.2003.09.055. PMID 15028364.
  6. Imazio, M.; Brucato, A.; Forno, D.; Ferro, S.; Belli, R.; Trinchero, R.; Adler, Y. (2012). "Efficacy and safety of colchicine for pericarditis prevention. Systematic review and meta-analysis". Heart. 98 (14): 1078–82. doi:10.1136/heartjnl-2011-301306. PMID 22442198. Unknown parameter |month= ignored (help)
  7. Imazio, M.; Bobbio, M.; Cecchi, E.; Demarie, D.; Demichelis, B.; Pomari, F.; Moratti, M.; Gaschino, G.; Giammaria, M. (2005). "Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial". Circulation. 112 (13): 2012–6. doi:10.1161/CIRCULATIONAHA.105.542738. PMID 16186437. Unknown parameter |month= ignored (help)
  8. Colchicine for pericarditis: a living systematic review. GitHub. Available at http://openmetaanalysis.github.io/Colchicine-for-Pericarditis/. Accessed November 16, 2014.
  9. 9.0 9.1 Imazio, M.; Brucato, A.; Cemin, R.; Ferrua, S.; Maggiolini, S.; Beqaraj, F.; Demarie, D.; Forno, D.; Ferro, S. (2013). "A Randomized Trial of Colchicine for Acute Pericarditis". N Engl J Med. doi:10.1056/NEJMoa1208536. PMID 23992557. Unknown parameter |month= ignored (help)
  10. Parikh, SV.; Memon, N.; Echols, M.; Shah, J.; McGuire, DK.; Keeley, EC. (2009). "Purulent pericarditis: report of 2 cases and review of the literature". Medicine (Baltimore). 88 (1): 52–65. doi:10.1097/MD.0b013e318194432b. PMID 19352300. Unknown parameter |month= ignored (help)
  11. Wheat, LJ.; Freifeld, AG.; Kleiman, MB.; Baddley, JW.; McKinsey, DS.; Loyd, JE.; Kauffman, CA. (2007). "Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (7): 807–25. doi:10.1086/521259. PMID 17806045. Unknown parameter |month= ignored (help)
  12. Adler Y, Zandman-Goddard G, Ravid M, Avidan B, Zemer D, Ehrenfeld M, Shemesh J, Tomer Y, Shoenfeld Y (1994). "Usefulness of colchicine in preventing recurrences of pericarditis". Am J of Cardiol. 73 (12): 916–7. doi:10.1016/0002-9149(94)90828-1. PMID 8184826.
  13. Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, Moratti M, Gaschino G, Giammaria M, Ghisio A, Belli R, Trinchero R (2005). "Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial". Circulation. 112 (13): 2012–6. doi:10.1161/CIRCULATIONAHA.105.542738. PMID 16186437.
  14. Imazio M, Bobbio M, Cecchi E, Demarie D, Pomari F, Moratti M, Ghisio A, Belli R, Trinchero R (2005). "Colchicine as first-choice therapy for recurrent pericarditis: results of the CORE (COlchicine for REcurrent pericarditis) trial". Arch Intern Med. 165 (17): 1987–91. doi:10.1001/archinte.165.17.1987. PMID 16186468.
  15. Little, William C.; Freeman, Gregory L. (2006). "Pericardial Disease". Circulation. 113 (12): 1622–1632. doi:10.1161/CIRCULATIONAHA.105.561514. ISSN 0009-7322.
  16. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  17. Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  18. Maisch, Bernhard; Seferović, Petar M.; Ristić, Arsen D.; Erbel, Raimund; Rienmüller, Reiner; Adler, Yehuda; Tomkowski, Witold Z.; Thiene, Gaetano; Yacoub, Magdi H.; Task Force on the Diagnosis and Management of Pricardial Diseases of the European Society of Cardiology (2004-04). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology". European Heart Journal. 25 (7): 587–610. doi:10.1016/j.ehj.2004.02.002. ISSN 0195-668X. PMID 15120056. Check date values in: |date= (help)
  19. Pankuweit, Sabine; Ristić, Arsen D.; Seferović, Petar M.; Maisch, Bernhard (2005). "Bacterial pericarditis: diagnosis and management". American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions. 5 (2): 103–112. ISSN 1175-3277. PMID 15725041.
  20. Goodman, null (2000-08). "Purulent Pericarditis". Current Treatment Options in Cardiovascular Medicine. 2 (4): 343–350. ISSN 1092-8464. PMID 11096539. Check date values in: |date= (help)
  21. Cherry, James (2014). Feigin and Cherry's textbook of pediatric infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455711772.
  22. Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  23. 23.0 23.1 23.2 Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y; et al. (2004). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology". Eur Heart J. 25 (7): 587–610. doi:10.1016/j.ehj.2004.02.002. PMID 15120056.
  24. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN; et al. (2003). "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis". Am J Respir Crit Care Med. 167 (4): 603–62. doi:10.1164/rccm.167.4.603. PMID 12588714.
  25. 25.0 25.1 Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M; et al. (2006). "ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation. 114 (10): e385–484. doi:10.1161/CIRCULATIONAHA.106.178233. PMID 16935995.
  26. Adler, Yehuda; Charron, Philippe; Imazio, Massimo; Badano, Luigi; Barón-Esquivias, Gonzalo; Bogaert, Jan; Brucato, Antonio; Gueret, Pascal; Klingel, Karin; Lionis, Christos; Maisch, Bernhard; Mayosi, Bongani; Pavie, Alain; Ristić, Arsen D.; Sabaté Tenas, Manel; Seferovic, Petar; Swedberg, Karl; Tomkowski, Witold (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X.
  27. Imazio, Massimo; Demichelis, Brunella; Parrini, Iris; Giuggia, Marco; Cecchi, Enrico; Gaschino, Gianni; Demarie, Daniela; Ghisio, Aldo; Trinchero, Rita (2004). "Day-hospital treatment of acute pericarditis". Journal of the American College of Cardiology. 43 (6): 1042–1046. doi:10.1016/j.jacc.2003.09.055. ISSN 0735-1097.
  28. Imazio, Massimo; Cecchi, Enrico; Demichelis, Brunella; Ierna, Salvatore; Demarie, Daniela; Ghisio, Aldo; Pomari, Franco; Coda, Luisella; Belli, Riccardo; Trinchero, Rita (2007). "Indicators of Poor Prognosis of Acute Pericarditis". Circulation. 115 (21): 2739–2744. doi:10.1161/CIRCULATIONAHA.106.662114. ISSN 0009-7322.
  29. 29.0 29.1 29.2 Lotrionte, Marzia; Biondi-Zoccai, Giuseppe; Imazio, Massimo; Castagno, Davide; Moretti, Claudio; Abbate, Antonio; Agostoni, Pierfrancesco; Brucato, Antonio L.; Di Pasquale, Pietro; Raatikka, Marja; Sangiorgi, Giuseppe; Laudito, Antonio; Sheiban, Imad; Gaita, Fiorenzo (2010). "International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences". American Heart Journal. 160 (4): 662–670. doi:10.1016/j.ahj.2010.06.015. ISSN 0002-8703.
  30. 30.0 30.1 30.2 Imazio, Massimo; Bobbio, Marco; Cecchi, Enrico; Demarie, Daniela; Demichelis, Brunella; Pomari, Franco; Moratti, Mauro; Gaschino, Gianni; Giammaria, Massimo; Ghisio, Aldo; Belli, Riccardo; Trinchero, Rita (2005). "Colchicine in Addition to Conventional Therapy for Acute Pericarditis". Circulation. 112 (13): 2012–2016. doi:10.1161/CIRCULATIONAHA.105.542738. ISSN 0009-7322.
  31. Imazio, Massimo; Brucato, Antonio; Cemin, Roberto; Ferrua, Stefania; Maggiolini, Stefano; Beqaraj, Federico; Demarie, Daniela; Forno, Davide; Ferro, Silvia; Maestroni, Silvia; Belli, Riccardo; Trinchero, Rita; Spodick, David H.; Adler, Yehuda (2013). "A Randomized Trial of Colchicine for Acute Pericarditis". New England Journal of Medicine. 369 (16): 1522–1528. doi:10.1056/NEJMoa1208536. ISSN 0028-4793.
  32. 32.0 32.1 32.2 Imazio, Massimo; Brucato, Antonio; Belli, Riccardo; Forno, Davide; Ferro, Silvia; Trinchero, Rita; Adler, Yehuda (2014). "Colchicine for the prevention of pericarditis". Journal of Cardiovascular Medicine. 15 (12): 840–846. doi:10.2459/JCM.0000000000000103. ISSN 1558-2027.
  33. 33.0 33.1 Alabed, Samer; Cabello, Juan B; Irving, Greg J; Qintar, Mohammed; Burls, Amanda (2014). "Colchicine for pericarditis". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD010652.pub2. ISSN 1465-1858.
  34. 34.0 34.1 Imazio, Massimo (2011). "Colchicine for Recurrent Pericarditis (CORP)". Annals of Internal Medicine. 155 (7): 409. doi:10.7326/0003-4819-155-7-201110040-00359. ISSN 0003-4819.
  35. 35.0 35.1 Imazio, Massimo; Belli, Riccardo; Brucato, Antonio; Cemin, Roberto; Ferrua, Stefania; Beqaraj, Federico; Demarie, Daniela; Ferro, Silvia; Forno, Davide; Maestroni, Silvia; Cumetti, Davide; Varbella, Ferdinando; Trinchero, Rita; Spodick, David H; Adler, Yehuda (2014). "Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial". The Lancet. 383 (9936): 2232–2237. doi:10.1016/S0140-6736(13)62709-9. ISSN 0140-6736.
  36. Imazio, Massimo; Brucato, Antonio; Cumetti, Davide; Brambilla, Giovanni; Demichelis, Brunella; Ferro, Silvia; Maestroni, Silvia; Cecchi, Enrico; Belli, Riccardo; Palmieri, Giancarlo; Trinchero, Rita (2008). "Corticosteroids for Recurrent Pericarditis". Circulation. 118 (6): 667–671. doi:10.1161/CIRCULATIONAHA.107.761064. ISSN 0009-7322.
  37. Imazio, Massimo; Brucato, Antonio; Adler, Yehuda; Brambilla, Giovanni; Artom, Galit; Cecchi, Enrico; Palmieri, Giancarlo; Trinchero, Rita (2007). "Prognosis of Idiopathic Recurrent Pericarditis as Determined from Previously Published Reports". The American Journal of Cardiology. 100 (6): 1026–1028. doi:10.1016/j.amjcard.2007.04.047. ISSN 0002-9149.
  38. Bertog, Stefan C.; Thambidorai, Senthil K.; Parakh, Kapil; Schoenhagen, Paul; Ozduran, Volkan; Houghtaling, Penny L.; Lytle, Bruce W.; Blackstone, Eugene H.; Lauer, Michael S.; Klein, Allan L. (2004). "Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy". Journal of the American College of Cardiology. 43 (8): 1445–1452. doi:10.1016/j.jacc.2003.11.048. ISSN 0735-1097.
  39. DeValeria, Patrick A.; Baumgartner, William A.; Casale, Alfred S.; Greene, Peter S.; Cameron, Duke E.; Gardner, Timothy J.; Gott, Vincent L.; Watkins, Levi; Reitz, Bruce A. (1991). "Current indications, risks, and outcome after pericardiectomy". The Annals of Thoracic Surgery. 52 (2): 219–224. doi:10.1016/0003-4975(91)91339-W. ISSN 0003-4975.
  40. Komoda, Takeshi; Frumkin, Alexander; Knosalla, Christoph; Hetzer, Roland (2013). "Child-Pugh Score Predicts Survival After Radical Pericardiectomy for Constrictive Pericarditis". The Annals of Thoracic Surgery. 96 (5): 1679–1685. doi:10.1016/j.athoracsur.2013.06.016. ISSN 0003-4975.
  41. Ling, Lieng H.; Oh, Jae K.; Schaff, Hartzell V.; Danielson, Gordon K.; Mahoney, Douglas W.; Seward, James B.; Tajik, A. Jamil (1999). "Constrictive Pericarditis in the Modern Era". Circulation. 100 (13): 1380–1386. doi:10.1161/01.CIR.100.13.1380. ISSN 0009-7322.

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