Pericardial Disease: Diagnosis and Management

• Published in: Mayo Clinic proceedings 2010-06, Vol.85 (6), p.572-593
• Main Authors: Khandaker, Masud H., MD, PhD, Espinosa, Raul E., MD, Nishimura, Rick A., MD, Sinak, Lawrence J., MD, Hayes, Sharonne N., MD, Melduni, Rowlens M., MD, Oh, Jae K., MD
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiac Tamponade - diagnosis; Cardiac Tamponade - therapy; Cardiology. Vascular system; Care and treatment; Development and progression; Diagnosis; Diseases of the pericardium; General aspects; Heart; Heart Diseases - diagnosis; Heart Diseases - therapy; Humans; Internal Medicine; Medical sciences; Miscellaneous; Pericardial Effusion - therapy; Pericarditis; Pericarditis - diagnosis; Pericarditis - drug therapy; Pericarditis, Constrictive - diagnosis; Pericardium - abnormalities; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk factors; Symposium on Cardiovascular Diseases
• ISSN: 0025-6196; 1942-5546
• DOI: 10.4065/mcp.2010.0046

Pericardial diseases can present clinically as acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis. Patients can subsequently develop chronic or recurrent pericarditis. Structural abnormalities including congenitally absent pericardium and pericardial cysts are usually asymptomatic and are uncommon. Clinicians are often faced with several diagnostic and management questions relating to the various pericardial syndromes: What are the diagnostic criteria for the vast array of pericardial diseases? Which diagnostic tools should be used? Who requires hospitalization and who can be treated as an outpatient? Which medical management strategies have the best evidence base? When should corticosteroids be used? When should surgical pericardiectomy be considered? To identify relevant literature, we searched PubMed and MEDLINE using the keywords diagnosis, treatment, management, acute pericarditis, relapsing or recurrent pericarditis, pericardial effusion, cardiac tamponade, constrictive pericarditis , and restrictive cardiomyopathy . Studies were selected on the basis of clinical relevance and the impact on clinical practice. This review represents the currently available evidence and the experiences from the pericardial clinic at our institution to help guide the clinician in answering difficult diagnostic and management questions on pericardial diseases.