Guidelines on the diagnosis and management of pericardial diseases … (original) (raw)

Diagnosis and Management of Pericardial Disease

Journal of Intensive Care Medicine, 2000

The pericardium serves many important functions but is not essential for life. Pericardial heart disease comprises only The pericardium is comprised of visceral and paripericarditis and its complications, tamponade and constriction, and congenital lesions. However, the pericardium is etal components; the visceral pericardium is a mesoaffected by virtually every category of disease. Thus the thelial monolayer that adheres firmly to epicardium, critical care physician is likely to encounter the patient with reflects over the origin of the great vessels, and with pericardial disease in a variety of settings, either as an isolated the tough, fibrous parietal pericardium envelops the phenomenon or as a complication of a variety of systemic heart. Pericardiosternal and diaphragmatic ligadisorders, trauma, or certain drugs. Despite exhaustive etiological lists, the cause of pericardial heart disease is often ments limit displacement of the pericardium and its never identified. This article reviews the diagnosis and mancontents within the chest. Chemo-and mechanoreagement of acute and chronic pericarditis with an emphasis ceptors with sympathetic afferents may be responsion those areas of greatest interest to the intensivist.

Pericardial disease: what the general cardiologist needs to know

Heart, 2007

__________________________ P ericardial disease remains an important cause of morbidity and mortality, spanning a complex spectrum from asymptomatic and transient to severely symptomatic and life threatening. Knowledge about the presenting symptoms, clinical findings, diagnosis and management is essential for effective clinical management.

Diagnosis and management of pericardial diseases

Nature Reviews Cardiology, 2009

| The management of pericardial diseases is largely empirical because of the relative lack of randomized trials that involve patients with these conditions. A first attempt to bring together and organize current knowledge resulted in the publication of the first guidelines on the management of pericardial diseases. Nevertheless, a number of observational studies and the first randomized trials are moving the management of pericardial diseases towards evidence-based medicine, particularly for pericarditis. Emerging data indicate that management can be tailored to the individual patient and, although the optimal duration of treatment is not clearly established, some recommendations can be formulated to guide management and follow-up.

Pericardial syndromes: an update after the ESC guidelines 2004

Heart Failure Reviews, 2013

Despite a myriad of causes, pericardial diseases present in few clinical syndromes. Acute pericarditis should be differentiated from aortic dissection, myocardial infarction, pneumonia/pleuritis, pulmonary embolism, pneumothorax, costochondritis, gastroesophageal reflux/ neoplasm, and herpes zoster. High-risk features indicating hospitalization are: fever [38°C, subacute onset, large effusion/tamponade, failure of non-steroidal anti-inflammatory drugs (NSAIDs), previous immunosuppression, trauma, anticoagulation, neoplasm, and myopericarditis. Treatment comprises 10-14-days NSAID plus 3 months colchicine (2 9 0.5 mg; 1 9 0.5 mg in patients \70 kg). Corticosteroids are avoided, except for autoimmunity, as they facilitate the recurrences. Echo-guided pericardiocentesis (±fluoroscopy) is indicated for tamponade and effusions [2 cm. Smaller effusions are drained if neoplastic, purulent or tuberculous etiology is suspected. In recurrent pericarditis, repeated testing for autoimmune and thyroid disease is appropriate. Pericardioscopy and pericardial/epicardial biopsy may clarify the etiology. Familial clustering was recently associated with tumor necrosis factor receptor-associated periodic syndrome (TNFRSF1A gene mutation). Treatment includes 10-14 days NSAIDs with colchicine 0.5 mg bid for up to 6 months. In nonresponders, low-dose steroids, intrapericardial steroids, azathioprine, and cyclophosphamide can be tried. Successful management with interleukin-1 receptor antagonist (anakinra) was recently reported. Pericardiectomy remains the last option in [2 years severely symptomatic patients. In constriction, expansion of the heart is impaired by the rigid, chronically inflamed/thickened pericardium (no thickening *20 %). Chest radiography, echocardiography, computerized tomography, magnetic resonance imaging, hemodynamics, and endomyocardial biopsy indicate the diagnosis. Pericardiectomy is the only treatment for permanent constriction. Predictors of poor survival are prior radiation, renal dysfunction, high pulmonary artery pressures, poor left ventricular function, hyponatremia, age, and simultaneous HIV and tuberculous infection.