What's the treatment for pericarditis?
The treatment of acute pericarditis depends on the cause. In general, the patient is told to rest in bed and to take aspirin or an anti-inflammatory drug, such as indomethacin (Indocin) for pain. If pain persists, the doctor may switch you to a glucocorticoid medication, such as prednisone (sold under several brand names). Patients with tuberculous pericarditis will
need anti-tuberculosis medication. Those with a pyogenic bacterial infection will need strong antibiotics. Patients with uremic pericarditis caused by kidney failure will need a more intensified program of hemodialysis.
Since most pericarditis is caused by a virus and will heal naturally, there is no specific, curative treatment. Ordinary antibiotics do not work against viruses. Pericarditis that comes from a virus usually clears up in two weeks to three months. Medications may be used to reduce inflammation, however. They include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. Corticosteroids are helpful if the pericarditis was caused by a heart attack or systemic lupus erythematosus. Analgesics (painkillers such as aspirin or acetaminophen) also may be given.
If the pericarditis recurs, removal of all or part of the pericardium (pericardiectomy) may be necessary. In the case of constrictive pericarditis, the pericardiectomy may be necessary to remove the stiffened parts of the pericardium that are preventing the heart from beating correctly. If a cardiac tamponade is present, it may be necessary to drain excess fluid from the pericardium. Pericardiocentesis, the same procedure used for testing, will be used to withdraw the fluid. For most people, home care with rest and medications to relieve pain are sufficient. A warm heating pad or compress also may help relieve pain. Sitting in an upright position and bending forward helps relieve discomfort. A person with pericarditis may also be kept in bed, with the head of the bed elevated to reduce the heart's need to work hard as it pumps blood. Along with painkillers and antibiotics, diuretic drugs ("water pills") to reduce fluids may also be used judiciously.
The operation to remove the pericardium is called surgical pericardectomy. Surgery may be considered if the pericardium is scarred and inflexible, or if pericarditis keeps recurring. The damaged parts of the pericardium are removed or the entire sac is cut away, depending on the severity. Even though the pericardium helps to support and protect the heart, its removal doesn't cause any harm. The heart can function perfectly well without it. |
