10th May 2025

Management

Treatment of pericardial disease is dependent on the type of pericardial disease manifestation, as well as  severity. The management involves a range of conservative watching and waiting measures, medical  management, and procedural measures. 

Pericarditis  

For pericarditis, first line therapy is NSAIDs with the goal of analgesia as well as resolution of inflammation. Indomethacin, or aspirin are commonly used. Patients who respond poorly or slowly to NSAIDs  may use Colchicine. It is also effective  in preventing recurrence of pericarditis, especially in the 72-hour  period. However the current treatment regime recommends a  combined therapy of both NSAIDs  and colchicine.

Table 3: treatment of pericarditis – adapted from European society of cardiology

Pericardial effusion 

Treatment of pericardial effusion if not causing any haemodynamic compromise is mainly conservative  watchful waiting (sometimes with serial echocardiography if indicated), with identification and  management of the initial cause of the effusion. Larger effusions may also merit a diagnostic  pericardiocentesis.  

Cardiac Tamponade 

The patient will most likely be shocked, and so in the first instance should be provided with oxygen,  volume expansion with crystalloid fluid, lower limb elevation. Vasopressor support may be needed. The  definitive treatment will involve removing the fluid in the pericardial space that is causing haemodynamic compromise by bedside pericardiocentesis. This is performed either using traditional landmark technique  in a sub-xiphoid window or using a point-of-care echo to guide needle placement in real-time. Patients  may also undergo a thoracotomy using the ‘clam shell’ approach, but this is reserved for traumatic arrests  with suspected tamponade.

Constrictive Pericarditis 

Diuretics can be used to reduce oedema or elevated venous pressure for control of symptoms. Patients  with newly diagnosed constrictive pericarditis who are hemodynamically stable and do not have signs or  symptoms of a chronic constriction (complete obliteration of the pericardial cavity by granulation tissue)  may be treated with anti-inflammatory agents for up to three months with close monitoring. The  definitive management however is a surgical pericardiectomy. There is a significant risk of mortality  associated with this procedure, therefore careful consideration of the co-morbidities of the patient as well  as the severity of the pericarditis must occur before a decision is made.