Acute pericarditis: features of diagnosis and treatment in real practice

Background. Acute pericarditis is an inflammatory disease of the pericardium that requires timely and accurate diagnosis to prevent potentially dangerous complications. This article reviews the key aspects of diagnosis and treatment of acute pericarditis in real clinical practice. Due to nonspecific clinical picture and absence of special diagnostic methods, diagnosis of acute pericarditis may cause difficulties. In about one third of patients, the course of the disease is recurrent, which requires assessment of possible risk factors for recurrent episodes of acute pericarditis. The clinical practice of management of patients with OP in the Russian Federation is limited to the description of individual cases.

Aim. To evaluate the peculiarities of management and treatment of patients with OP in the hospital register.

Materials and methods. A retrospective study was carried out in Moscow hospitals Moscow City Hospital named after S.S. Yudin and Pirogov City Clinical Hospital №1 from January 2023 to September 2024. The protocol was approved by the ethical committee of the Sechenov First Moscow State Medical University (Sechenov University). The charts of patients diagnosed with OP were analyzed. Inclusion criteria: age ≥18 years, presence of 2 of 4 major criteria for OP. Patients with HIV, pregnancy, acute psychiatric conditions and severe chronic renal failure (pSCF<15 ml/min/1.73 m²) were excluded.

Results. Forty patients with OP were included. Consistency of diagnostic characteristics with the grand diagnostic criteria was assessed 1 of 4 grand criteria occurred in 7 (17%) cases; 2 of 4 occurred in 25 (63%) individuals, 3 of 4 in 8 (20%); complete compliance with all criteria was absent. 27 (68%) patients had ECG changes, ST segment elevation in 24 (60%), but only 3 (13%) had changes in all leads. PQ depression and pericardial friction murmur were not recorded. OP was diagnosed on the day of hospitalization in 29 (73%) patients, in 11 (27%) – on the 2nd day after CAG. Four (10%) developed acute heart failure requiring diuretics. Monotherapy with NSAIDs was used in 21 (53%) patients, combined therapy with NSAIDs + colchicine – in 6 (15%). Bacterial etiology of OP besides antibiotics also requires prescription of combination of NSAIDs/HCS + colchicine. In the discussed study, therapy with NSAIDs, GCS and colchicine was initiated only when antibiotic therapy was ineffective, which is not in accordance with clinical guidelines. The dosage of NSAIDs was in accordance with recommendations in 40% of cases, adequate dose of colchicine in 28%. Combination therapy at discharge was recommended in 21 (52.5%) cases; correct doses and timing were indicated in 18 (44%) and 7 (17.5%) patients.

Conclusion. The diagnosis of OP was more often made in the first day; in the rest, the delay in diagnosis was associated with troponin elevation and ST segment elevation on ECG, which requires CAG for differential diagnosis. The main errors of treatment: incorrect doses of NSAIDs/GCS, absence of colchicine in therapy and terms of its administration in discharge epicrises, as well as absence of information about physical load limitations.