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Clinical presentation and diagnostic evaluation of acute pericarditis

Author
Massimo Imazio, MD, FESC
Section Editor
Martin M LeWinter, MD
Deputy Editor
Brian C Downey, MD, FACC

INTRODUCTION

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 [1]:

Acute and recurrent pericarditis

Pericardial effusion without major hemodynamic compromise

Cardiac tamponade

                        

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Literature review current through: Nov 2016. | This topic last updated: Tue Feb 02 00:00:00 GMT 2016.
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References
Top
  1. Imazio M. Contemporary management of pericardial diseases. Curr Opin Cardiol 2012; 27:308.
  2. Spodick DH. Acute cardiac tamponade. N Engl J Med 2003; 349:684.
  3. Kytö V, Sipilä J, Rautava P. Clinical profile and influences on outcomes in patients hospitalized for acute pericarditis. Circulation 2014; 130:1601.
  4. Imazio M, Cecchi E, Demichelis B, et al. Myopericarditis versus viral or idiopathic acute pericarditis. Heart 2008; 94:498.
  5. Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet 2004; 363:717.
  6. Lange RA, Hillis LD. Clinical practice. Acute pericarditis. N Engl J Med 2004; 351:2195.
  7. Little WC, Freeman GL. Pericardial disease. Circulation 2006; 113:1622.
  8. Heidenreich PA, Eisenberg MJ, Kee LL, et al. Pericardial effusion in AIDS. Incidence and survival. Circulation 1995; 92:3229.
  9. Chen Y, Brennessel D, Walters J, et al. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J 1999; 137:516.
  10. Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015; 314:1498.
  11. Imazio M, Demichelis B, Parrini I, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol 2004; 43:1042.
  12. Spodick DH. Acute pericarditis: current concepts and practice. JAMA 2003; 289:1150.
  13. Spodick, DH. Acute, clinically noneffusive ("dry") pericarditis. In: Spodick DH: The Pericardium: A Comprehensive Textbook, Marcel Dekker, New York 1997. p.94-113.
  14. Spodick DH. Pericardial rub. Prospective, Multiple observer investigation of pericardial friction in 100 patients. Am J Cardiol 1975; 35:357.
  15. Zayas R, Anguita M, Torres F, et al. Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol 1995; 75:378.
  16. Rutsky EA, Rostand SG. Pericarditis in end-stage renal disease: Clinical characteristics and management. Semin Dial 1989; 2:25.
  17. Spodick, DH. The Pericardium: A Comprehensive Textbook, Marcel Dekker, New York 1997. p.46-64.
  18. Chou TC. Electrocardiography in clinical practice, WB Saunders Company, Philadelphia 1996.
  19. Spodick DH. Arrhythmias during acute pericarditis. A prospective study of 100 consecutive cases. JAMA 1976; 235:39.
  20. Chou TC. Electrocardiography in Clinical Practice: Adults and Pediatrics, 4th ed, WB Saunders, Philadelphia 1996.
  21. Klatsky AL, Oehm R, Cooper RA, et al. The early repolarization normal variant electrocardiogram: correlates and consequences. Am J Med 2003; 115:171.
  22. Spodick DH. Differential characteristics of the electrocardiogram in early repolarization and acute pericarditis. N Engl J Med 1976; 295:523.
  23. Ginzton LE, Laks MM. The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria. Circulation 1982; 65:1004.
  24. Imazio M, Demichelis B, Cecchi E, et al. Cardiac troponin I in acute pericarditis. J Am Coll Cardiol 2003; 42:2144.
  25. Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2013; 26:965.
  26. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline for the clinical application of echocardiography www.acc.org/qualityandscience/clinical/statements.htm (Accessed on August 24, 2006).
  27. Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol 1985; 56:623.
  28. Imazio M, Bobbio M, Cecchi E, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation 2005; 112:2012.
  29. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36:2921.
  30. Imazio M, Cecchi E, Demichelis B, et al. Indicators of poor prognosis of acute pericarditis. Circulation 2007; 115:2739.
  31. Maisch B, Ristić AD. The classification of pericardial disease in the age of modern medicine. Curr Cardiol Rep 2002; 4:13.
  32. Permanyer-Miralda G. Acute pericardial disease: approach to the aetiologic diagnosis. Heart 2004; 90:252.
  33. Imazio M, Trinchero R. Clinical management of acute pericardial disease: a review of results and outcomes. Ital Heart J 2004; 5:803.
  34. Imazio M, Spodick DH, Brucato A, et al. Controversial issues in the management of pericardial diseases. Circulation 2010; 121:916.
  35. Imazio M, Brucato A, Derosa FG, et al. Aetiological diagnosis in acute and recurrent pericarditis: when and how. J Cardiovasc Med (Hagerstown) 2009; 10:217.