Recurrent Pericarditis Challenges
Recurrent pericarditis is a common complication after an initial episode of acute pericarditis, characterized by the recurrence of chest pain and signs of cardiovascular inflammation. Recurrent pericarditis presents major short-term and long-term challenges for clinicians and patients alike.
For many individuals, the first acute episode of pericarditis is just the beginning, with up to 30% of these patients experiencing a first recurrence within 18 months. Data suggests there are approximately 40,000 recurrent pericarditis patients in the United States (US) seeking and receiving medical treatment. The impact of recurrent pericarditis often extends beyond cardiac effects, with general uncertainty of each recurrence triggering anxiety, depression, and disruption in overall quality of life.
Pericarditis is inflammation of the fibroelastic pericardial sac.
Acute pericarditis has been observed in ≈0.1% of hospitalized patients and 5% of patients admitted to the emergency department with a diagnosis of noncardiac chest pain.
Videos On Demand
This webinar will explore the features of monogenic autoinflammatory diseases as a paradigm for IL-1 mediated recurrent pericarditis. It will also highlight pericarditis as a feature of systemic autoimmune disease and offer pearls for recognizing and diagnosing these conditions. Finally, advances in our understanding of the pathophysiology of these conditions has led to many effective treatments. However, for a small minority of patients who are refractory to or intolerant of modern medical therapy, surgical pericardiectomy remains a treatment option. The third part of this webinar will present surgical indications for pericardiectomy, surgical approach, and risk/benefit of surgery.
Acute pericarditis is a common and important clinical problem responsible for ~5% of patients attending the emergency department with chest pain. For most patients, the condition is self-limiting and resolves with the use of non-steroidal anti-inflammatory drugs and colchicine. However, about a third of patients can develop recurrent disease which can cause significant morbidity and can be challenging to manage. The risk of this occurring can be reduced by timely diagnosis and appropriate initial medical therapy. This webinar will review the initial diagnosis and clinical evaluation of pericarditis. It will also address risk stratification and outline therapeutic approaches to initial management and preventing recurrence, and the related practical pharmacology.
Recurrent Pericarditis: Epidemiology, Presentation, Pathophysiology, Diagnostic Testing, Newest Treatments, and Complication Awareness
Recurrent pericarditis is a clinical condition that can be complex when it comes to diagnosis and treatment as patients are often lacking symptoms until several weeks after an acute pericarditis episode. Enhance your clinical practice with the most up-to-date information provided by experts in the field. This webinar provides key takeaways for initial diagnosis and clinical evaluation strategies in recurrent pericarditis. Advances in understanding the pathophysiology and the newest treatments will be highlighted to improve clinical management and decease complications.
Long Term Complications of Recurrent Pericarditis
Presenters: Janet Kloos, RN, PhD, APRN-CCNS, CCRN; Allen Luis, MD; C. Barton Gillombardo, MD; Brian Hoit, MD
Complicated pericarditis can occur in 15-30% of patients after an episode of acute pericarditis. Risk factors include non-response to NSAID’s, early use of corticosteroids and high CRP. Incessant pericarditis occurs when symptoms are consistent and last longer than 4 weeks after an acute episode. Chronic pericarditis is diagnosed when symptoms last longer than 3 months. The number and duration of recurrence implies the morbidity of pericarditis. Pain is a predominant disabling feature of chronic pericarditis. Constrictive pericarditis occurs when diastolic filling is impaired by an inelastic pericardium. Differentiation between constrictive pericarditis and restrictive cardiomyopathy can be difficult. Identifying an underlying cause of the clinical features during history-taking may be beneficial. In developed nations, idiopathic and post cardiac surgery are most frequent causes of constrictive pericarditis. In developing and underdeveloped nations and in immunosuppressed patients, tuberculosis is the major cause. This podcast will review the initial diagnosis, clinical evaluation and treatment of the long-term complications of recurrent pericarditis. Listen Now!
Recurrent Pericarditis in Systemic Autoinflammatory and Autoimmune Disease – Clinical Recognition and Management
Presenters: Tevfik Ismail, MB, BS, PhD, FRCP, FACC, FAHA; Claire Peet, MD; Shreyasee Amin, MD, CM, MPH
While healthcare providers may initiate corticosteroids in patients with recurrent pericarditis, patients with autoimmune rheumatic disease and cardiac involvement should also be managed in collaboration with a rheumatologist particularly. In this podcast, experts explore in more detail the diagnosis and clinical features of monogenic autoinflammatory diseases many of which can present with recurrent pericarditis. In addition, discussion will include the spectrum of autoimmune diseases complicated by pericarditis, how to recognize these clinically, and when to call for help. Listen Now!
Recurrent Pericarditis: The Role of IL-1 Blockade
Presenters: Allen Luis, MD; Anene Ukaigwe, MD; Cyrille K. Cornelio, Pharm.D., BCCP
In 2021, the FDA-approved Rilonacept to treat recurrent pericarditis and reduce the risk of recurrence. In this podcast learn more about the role interleukin-1 (IL-1) plays in the pathophysiology of pericarditis. Listen Now!
Pathophysiology of Recurrent Pericarditis
Presenters: Paul Cremer, MD; Aisha Siraj, MD, FACC; Antonio Abbate, MD, PhD
Listen to this podcast to better understand the triggers causing recurrent episodes of pericarditis. Experts discuss how to assess those triggers to direct optimal therapy.
Beyond Acute – Recurrent Pericarditis
Presenters: Katherine E. Di Palo, PharmD, FAHA, FHFSA, BCACP, BCGP; Farshad Forouzandeh, MD, PhD, FACC, FSCAI; David Lin, MD
In this podcast, Drs. Forouzandeh, Lin, and Di Palo discuss initial management of recurrent pericarditis. Learn how to distinguish acute pericarditis from recurrent pericarditis. They will also explore diagnostic criteria and initial pharmacotherapy for recurrent pericarditis. Listen now to get more insight on care delivery strategies to improve patient outcomes and decrease associated health care costs due to recurrent pericarditis.
Treatment of Acute Pericarditis
Presenters: Tevfik F Ismail, MB, BS, PhD, FRCP, FACC, FAHA; Antonio Brucato, MD; Robert Barcelona, Pharm.D., BCPS
In this podcast, Drs. Tevfik Ismail, Antonio Brucato, and Robert Barcelona will focus on the treatment of acute pericarditis and review the relevant clinical pharmacology of the agents used. Learn more on the use of drugs that are off-label for acute pericarditis in the United States and other jurisdictions and some practical tips and tricks and pointers towards pitfalls to avoid when managing this condition.
Complications of Acute Pericarditis
Presenters: Christine L. Jellis, MD PhD FACC FASE; Tim Simpson, MD, Pharm D, and Sadeer Al-Kindi, MD, FACC.
Summary: Learn more in this podcast on the causes, complications and treatments of acute pericarditis and explore how to prevent an initial episode of acute pericarditis from evolving into recurrent pericarditis.
What is Acute Pericarditis: Signs and Signals
Presenters: S. Allen Luis, MD, PhD, FRACP, FACC, FASE; James Lloyd, MD; Janet A. Kloos, RN, PhD, APRN-CCNS, CCRN
Summary: Pericarditis is inflammation of the fibroelastic pericardial sac. Acute pericarditis has been observed in ≈0.1% of hospitalized patients and 5% of patients admitted to the emergency department with a diagnosis of noncardiac chest pain. In this podcast, learn the clinical features of Acute Pericarditis.
Guidelines and Articles
- 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes (PDF)
- Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation. 2018;137:e30–e66.
- ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation - Full Text. Circulation. 2006;114:e257–e354.