Clinical presentation and diagnostic evaluation of acute pericarditis
- Massimo Imazio, MD, FESC
Massimo Imazio, MD, FESC
- Professor of Physiology
- University Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino.
- Department of Public Health and Pediatrics, University of Torino.
The pericardium is a fibroelastic sac made up of visceral and parietal layers separated by a (potential) space, the pericardial cavity. In healthy individuals, the pericardial cavity contains 15 to 50 mL of an ultrafiltrate of plasma. Pericardial diseases are relatively common in clinical practice and may have different presentations either as isolated disease or as a manifestation of a systemic disorder. Although the etiology is varied and complex, the pericardium has a relatively non-specific response to these different causes with inflammation of the pericardial layers and possible increased production of pericardial fluid. Chronic inflammation with fibrosis and calcification can lead to a rigid, usually thickened and calcified pericardium, with possible progression to pericardial constriction.
Diseases of the pericardium present clinically in one of several ways :
●Acute and recurrent pericarditis
●Pericardial effusion without major hemodynamic compromise
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- CLINICAL FEATURES
- Chest pain
- Pericardial friction rub
- - ECG differentiation from acute myocardial infarction
- - ECG differentiation from early repolarization
- Laboratory and imaging findings
- - Echocardiogram
- - Chest x-ray
- - Cardiac biomarkers
- - Signs of inflammation
- Clinical diagnostic criteria
- - Acute pericarditis
- IDENTIFYING THE ETIOLOGY
- Indications for pericardiocentesis and pericardial biopsy
- - Pericardiocentesis
- - Pericardial biopsy
- DETERMINATION OF RISK AND NEED FOR HOSPITALIZATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS