Treating pericarditis, including congestive pericarditis (inflammation of the pericardium), often relies on treating the underlying cause, which will relieve the pericarditis. For example, pericarditis caused by rheumatic fever would require treatment with antibiotics, whereas the pericarditis caused by kidney failure would be treated with dialysis. Some cases may require a hospital stay to monitor for signs of cardiac tamponade, present in about 15 percent of cases of acute pericarditis.

If the cause of the condition is not clear, relieving the chest pain and inflammation becomes central to treatment. This may be accomplished through the administration of nonsteroidal anti–inflammatories (NSAIDs), such as aspirin or ibuprofen. These drugs treat the actual inflammation of the pericardium. They may be prescribed at relatively high doses (300 mg to 800 mg, every six to eight hours) for days or weeks, then gradually tapered off as the symptoms receded. In addition, there is evidence that the anti-gout drug cochicline may help relieve the inflammation. This drug may be prescribed in conjunction with NSAIDs. Patients suffering from such chest pain should also refrain from strenuous physical activity.

If the more common anti-inflammatories are not sufficient to relieve symptoms, steroids may be prescribed. These medications are usually effective in alleviating pain by reducing inflammation, but initially prescribed (maximum) dosages should not be used for more than two weeks, as prolonged use increases the risk of bone thinning, high blood pressure, elevated blood sugar, suppression of the immune system and stomach ulcers, among other side effects. 

Diuretics may also be used. These prescription medications are used to remove excess fluid that has accumulated in the pericardial sac.

In severe cases of pericarditis where cardiac tamponade or pericardial effusion is present, a procedure called pericardiocentesis may be required. This treatment involves drainage of the fluid in the pericardial sac through the use of a needle and, if necessary, a catheter. By draining the fluid, pressure against the heart muscle can be relieved and normal blood flow may be restored.

If pericardiocentesis is not successful, or if other complications are present, then further intervention may be necessary, including:

The inflammation associated with acute pericarditis may resolve itself in a matter of weeks. However, there is a possibility of the condition recurring, particularly within two years of the first episode, even if the underlying condition has been successfully treated. This complication affects up to 30 percent of patients with pericarditis, and management is usually possible through the use of anti-inflammatory medications for several months. Left untreated, pericarditis can lead to chronic constrictive pericarditis with subsequent heart failure.

Cardiac tamponade is an emergency condition that requires prompt treatment to avoid serious or even fatal consequences.