Understanding Treatment Goals

The main goal in treating pericarditis is to reduce inflammation, relieve pain, prevent recurrence, and avoid complications like pericardial effusion or constrictive pericarditis. Treatment varies depending on the type (acute, recurrent, or chronic), the underlying cause, and the severity of the condition. Most cases respond well to medication, but some require hospitalization or even surgery.

Initial Rest and Monitoring

In cases of mild pericarditis, especially of viral origin, rest is often the first step. Physical activity can worsen inflammation, so doctors usually recommend avoiding exertion until symptoms resolve and inflammatory markers return to normal.

Monitoring may include:

  • Regular physical exams

  • Blood tests (CRP, ESR)

  • ECG and echocardiogram follow-ups

This conservative approach helps the body heal naturally while tracking for potential complications.

NSAIDs: First-Line Treatment

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of pericarditis treatment. They work by blocking enzymes that cause inflammation, reducing both swelling and pain in the pericardium.

Commonly used NSAIDs include:

  • Ibuprofen (600–800 mg every 8 hours)

  • Aspirin (750–1000 mg every 8 hours)

  • Indomethacin (25–50 mg every 8 hours)

Treatment typically lasts 1–2 weeks, depending on symptom resolution and inflammatory markers. Patients must take these drugs with food to avoid gastrointestinal side effects.

Colchicine: Preventing Recurrence

Colchicine is often used alongside NSAIDs to enhance treatment and reduce the risk of recurrence. It’s especially effective in preventing recurrent pericarditis, which can be challenging to manage.

The typical dosage:

  • 0.5–1 mg/day, continued for 3–6 months in acute cases

  • Up to 12 months in recurrent cases

Colchicine may cause gastrointestinal issues like diarrhea, but these are generally manageable. It’s not recommended for people with severe kidney or liver dysfunction.

Corticosteroids: For Resistant Cases

Corticosteroids like prednisone are reserved for patients who do not respond to NSAIDs and colchicine or who cannot tolerate them. They are also used in cases linked to autoimmune diseases.

Typical dose:

  • 0.2–0.5 mg/kg/day of prednisone

While effective at controlling inflammation, corticosteroids come with side effects such as weight gain, mood swings, increased infection risk, and bone thinning. Tapering the dose slowly is essential to prevent rebound pericarditis.

Antibiotics and Antifungals

If pericarditis is caused by bacterial or fungal infections, targeted antimicrobial therapy is required.

  • Bacterial pericarditis: Requires IV antibiotics, often followed by oral treatment

  • Tuberculous pericarditis: Treated with a multi-drug anti-tuberculosis regimen for 6–12 months

  • Fungal pericarditis: Needs antifungal medications like amphotericin B or fluconazole

Early diagnosis and treatment are crucial in infectious cases, as delays can lead to severe complications like abscess or tamponade.

Antiviral Therapy

Most viral pericarditis cases are self-limiting and do not need antiviral drugs. However, in immunocompromised patients or cases caused by specific viruses like HIV or cytomegalovirus, antivirals may be indicated.

Supportive care remains the mainstay in viral pericarditis unless a specific virus is identified and treated accordingly.

Immunosuppressive Agents

In autoimmune or refractory cases, immunosuppressive drugs may be used to calm the overactive immune response.

Options include:

  • Azathioprine

  • Methotrexate

  • Intravenous immunoglobulin (IVIG)

  • Anakinra (IL-1 receptor antagonist)

These drugs are used under specialist supervision, particularly in chronic pericarditis or autoimmune diseases like lupus and rheumatoid arthritis.

Pericardiocentesis: Draining Excess Fluid

In patients with significant pericardial effusion or cardiac tamponade, pericardiocentesis is a lifesaving procedure. It involves inserting a needle into the pericardial sac to remove excess fluid, relieving pressure on the heart.

This procedure is usually performed under ultrasound or fluoroscopic guidance in a hospital setting. In addition to relieving symptoms, the fluid is analyzed to identify the cause of the effusion.

Pericardial Window Surgery

When fluid continues to accumulate despite pericardiocentesis, a pericardial window procedure may be performed. This surgical technique involves creating a small hole in the pericardium to allow continuous drainage into the chest cavity.

This is commonly used in cancer-related pericarditis or recurrent effusion cases. It can be performed via minimally invasive thoracoscopy or open surgery.

Pericardiectomy: Last-Resort Option

In chronic, constrictive, or treatment-resistant pericarditis, surgical removal of the pericardium—pericardiectomy—may be necessary. This complex procedure restores normal cardiac function by freeing the heart from the scarred, thickened pericardium.

Indications include:

  • Constrictive pericarditis

  • Persistent symptoms despite medication

  • Frequent hospitalizations

Although effective, the surgery carries risks, including bleeding, infection, or damage to the heart. It should be performed in specialized centers.

Hospitalization Criteria

Patients with any of the following are usually admitted to the hospital:

  • High fever (>38°C)

  • Large pericardial effusion

  • Cardiac tamponade

  • Immunosuppression

  • Trauma-related pericarditis

  • Poor response to outpatient therapy

Hospital care allows close monitoring and quick escalation of treatment if needed.

Lifestyle Adjustments

Lifestyle changes can help support recovery and prevent recurrence:

  • Rest during flare-ups to reduce strain on the heart

  • Avoid intense exercise until fully recovered

  • Reduce stress, which can worsen inflammation

  • Eat an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fats

  • Avoid alcohol and smoking

Staying hydrated, getting adequate sleep, and following prescribed treatment are equally important.

Long-Term Management

Some patients experience recurrent or chronic pericarditis requiring extended care. This involves:

  • Regular follow-ups with cardiology

  • Periodic imaging and lab tests

  • Adjustment of medication dosages

  • Monitoring for side effects

Support groups, physical therapy, and mental health care can also be part of a holistic recovery plan.

Pediatric Considerations

Children with pericarditis are treated similarly, though dosing is weight-based and monitored more closely. NSAIDs and colchicine are first-line drugs, while steroids are used more cautiously.

Pediatric cardiologists should be involved in cases of recurrence or complications, especially if related to congenital heart conditions or autoimmune disorders.

COVID-19 and Treatment Updates

Recent cases of pericarditis have emerged after COVID-19 infection or vaccination. Treatment protocols remain similar, though careful cardiac evaluation is needed to distinguish from myocarditis or long COVID symptoms.

Ongoing research is exploring the use of targeted biologics and anti-IL-1 therapies like anakinra in post-viral or recurrent pericarditis.

Outlook and Recovery

With early and appropriate treatment, most cases of pericarditis resolve without long-term damage. Recovery times vary:

  • Acute pericarditis: 1–3 weeks

  • Recurrent pericarditis: Up to several months

  • Constrictive pericarditis: May require surgery for full recovery

Prognosis is excellent in viral and idiopathic cases. However, those linked to cancer, TB, or autoimmune diseases require ongoing care and may have a more complex course.

Conclusion: Tailored Treatment Saves Lives

Treating pericarditis isn’t one-size-fits-all. From NSAIDs and colchicine to advanced surgical interventions, the treatment approach depends on the cause, severity, and individual patient profile. Early diagnosis, personalized care, and consistent follow-up are the keys to full recovery and improved quality of life.

If you're experiencing persistent chest pain or shortness of breath, don’t ignore the signs—speak to your doctor about your symptoms and get the care you need.