[Treatment of acute and recurrent pericarditis. What the clinical cardiologist should know]

Pericarditis is a common clinical problem, above all in its incessant and recurrent forms. Treatment should be targeted according to etiology, but this is often unfeasible with a conventional approach, because most cases are labeled as "idiopathic" in the majority of immunocompetent patients from developed countries. Clinical risk stratification of acute pericarditis may be useful to select patients who should be admitted to hospital, and in whom a complete evaluation should be performed to identify causes that require specific therapy. In idiopathic and viral pericarditis the mainstay of treatment is the use of aspirin or a nonsteroidal anti-inflammatory drug with the possible adjunct of colchicine to prevent recurrences, above all in recurrent pericarditis. Corticosteroids are too often considered and should be limited to rare, specific indications (definite rheumatologic disease, presumed autoimmune etiology, intolerance or contraindications to aspirin or non-steroidal anti-inflammatory drugs, pregnancy) being a clear risk factor for a prolonged and chronic course of the disease in idiopathic or viral forms. Despite the common fear of a possible evolution towards constrictive pericarditis, such complication is not recorded in acute and recurrent pericarditis of viral and idiopathic etiology. The prognosis is good in these cases and the risk of constriction is related to the presence of a specific etiology and not to the number of recurrences.