Acute Pericarditis with Tamponade | Patient Case Quiz
A 43-year-old woman with a past medical history notable only for tobacco use presented to the hospital with chest pain and dyspnea.
The chest pain was substernal, sharp, pleuritic, and radiated to both shoulders. It had been present for two days but became progressively worse and was associated with dyspnea which prompted her to present for medical attention. She also noted that she had an upper respiratory infection that started about a week before these symptoms began. She had a family history of sarcoidosis but no personal history of any autoimmune disorder.
Initial vital signs were notable for tachycardia at 120 beats per minute. Physical exam was normal and no friction rub was auscultated on exam.
Initial ECG (Fig 1) showed diffuse ST elevations with PR depression and an initial echocardiogram showed a large circumferential pericardial effusion with right ventricular collapse (Fig 2). An erythrocyte sedimentation rate was elevated at 60mm/h.
She underwent urgent pericardiocentesis with removal of 400cc of straw colored fluid. Cytopathology noted many inflammatory cells with no malignant cells. A viral respiratory panel was negative. Cardiac magnetic resonance imaging (Fig 3) after pericardiocentesis suggested ongoing pericardial inflammation.
This patient was treated initially with high dose non-steroidal anti-inflammatory medication and colchicine. Provided the patient responds, how long should the colchicine therapy be continued?