Etiology of pericardial disease
- Brian D Hoit, MD
Brian D Hoit, MD
- Professor of Medicine and Physiology and Biophysics
- Case Western Reserve University and University Hospitals of Cleveland
- Section Editors
- Martin M LeWinter, MD
Martin M LeWinter, MD
- Section Editor — Myopericardial Disease
- Professor of Medicine and Molecular Physiology and Biophysics
- University of Vermont
- Jae K Oh, MD
Jae K Oh, MD
- Section Editor — Myopericardial Disease
- Professor of Medicine
- Mayo Clinic College of Medicine
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. In some cases, the clinical presentation of acute pericardial inflammation predominates, and the presence of excess pericardial fluid is clinically unimportant. In other cases, the effusion and its clinical consequences (ie, cardiac tamponade and constrictive pericarditis) are of primary importance.
Diseases of the pericardium present clinically in one of several ways [1,2]:
●Acute and recurrent pericarditis
●Pericardial effusion without major hemodynamic compromise
- Imazio M. Contemporary management of pericardial diseases. Curr Opin Cardiol 2012; 27:308.
- 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.
- Spodick DH. The Pericardium: A Comprehensive Textbook, Marcel Dekker, New York 1997. p.260.
- Spodick DH. Pericardial disease. In: Heart Disease: A Textbook of Cardiovascular Medicine, Braunwald E, Zipes D, Libby P (Eds), Saunders, New York 2001. p.183.
- Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet 2004; 363:717.
- Caforio AL, Brucato A, Doria A, et al. Anti-heart and anti-intercalated disk autoantibodies: evidence for autoimmunity in idiopathic recurrent acute pericarditis. Heart 2010; 96:779.
- Maestroni S, Di Corato PR, Cumetti D, et al. Recurrent pericarditis: autoimmune or autoinflammatory? Autoimmun Rev 2012; 12:60.
- Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015; 314:1498.
- Sagristà-Sauleda J, Mercé J, Permanyer-Miralda G, Soler-Soler J. Clinical clues to the causes of large pericardial effusions. Am J Med 2000; 109:95.
- Corey GR, Campbell PT, Van Trigt P, et al. Etiology of large pericardial effusions. Am J Med 1993; 95:209.
- Levy PY, Corey R, Berger P, et al. Etiologic diagnosis of 204 pericardial effusions. Medicine (Baltimore) 2003; 82:385.
- Atar S, Chiu J, Forrester JS, Siegel RJ. Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s? Chest 1999; 116:1564.
- Ben-Horin S, Bank I, Guetta V, Livneh A. Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. Medicine (Baltimore) 2006; 85:49.
- 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.
- 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.
- Imazio M, Spodick DH, Brucato A, et al. Controversial issues in the management of pericardial diseases. Circulation 2010; 121:916.
- Campbell PT, Li JS, Wall TC, et al. Cytomegalovirus pericarditis: a case series and review of the literature. Am J Med Sci 1995; 309:229.
- Galve E, Garcia-Del-Castillo H, Evangelista A, et al. Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance. Circulation 1986; 73:294.
- Correale E, Maggioni AP, Romano S, et al. Comparison of frequency, diagnostic and prognostic significance of pericardial involvement in acute myocardial infarction treated with and without thrombolytics. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI). Am J Cardiol 1993; 71:1377.
- Belkin RN, Mark DB, Aronson L, et al. Pericardial effusion after intravenous recombinant tissue-type plasminogen activator for acute myocardial infarction. Am J Cardiol 1991; 67:496.
- Shahar A, Hod H, Barabash GM, et al. Disappearance of a syndrome: Dressler's syndrome in the era of thrombolysis. Cardiology 1994; 85:255.
- Stevenson LW, Child JS, Laks H, Kern L. Incidence and significance of early pericardial effusions after cardiac surgery. Am J Cardiol 1984; 54:848.
- Hauptman PJ, Couper GS, Aranki SF, et al. Pericardial effusions after cardiac transplantation. J Am Coll Cardiol 1994; 23:1625.
- Quin JA, Tauriainen MP, Huber LM, et al. Predictors of pericardial effusion after orthotopic heart transplantation. J Thorac Cardiovasc Surg 2002; 124:979.
- Stewart JR, Fajardo LF, Gillette SM, Constine LS. Radiation injury to the heart. Int J Radiat Oncol Biol Phys 1995; 31:1205.
- Applefeld MM, Wiernik PH. Cardiac disease after radiation therapy for Hodgkin's disease: analysis of 48 patients. Am J Cardiol 1983; 51:1679.
- Mandell BF. Cardiovascular involvement in systemic lupus erythematosus. Semin Arthritis Rheum 1987; 17:126.
- Rostand SG, Rutsky EA. Pericarditis in end-stage renal disease. Cardiol Clin 1990; 8:701.
- Gunukula SR, Spodick DH. Pericardial disease in renal patients. Semin Nephrol 2001; 21:52.
- Kabadi UM, Kumar SP. Pericardial effusion in primary hypothyroidism. Am Heart J 1990; 120:1393.
- Sekiguchi H, Horie R, Suri RM, et al. Constrictive pericarditis caused by immunoglobulin G4-related disease. Circ Heart Fail 2012; 5:e30.
- SPECTRUM OF CLINICAL PRESENTATION
- Acute pericarditis
- Pericardial effusion
- - Hemorrhagic pericardial effusion
- - Symptomatic pericardial effusion
- Constrictive pericarditis
- Effusive constrictive pericarditis
- ESTABLISHING THE DIAGNOSIS
- Other infectious causes
- POST-CARDIAC INJURY SYNDROMES
- DRUGS AND TOXINS
- SYSTEMIC DISORDERS
- INFORMATION FOR PATIENTS