Medicine › Cardiology and Cardiovascular Medicine

Pericarditis and Cardiac Tamponade

Works Count: 31678

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Description

This cluster of papers focuses on the diagnosis and management of pericardial diseases, including pericarditis, constrictive pericarditis, and tuberculous pericarditis. It explores the use of colchicine therapy, echocardiography, and cardiac magnetic resonance imaging in the evaluation and treatment of these conditions.

Keywords

Pericarditis; Constrictive Pericarditis; Colchicine Therapy; Echocardiography; Cardiac Tamponade; Multimodality Imaging; Tuberculous Pericarditis; Pericardiectomy; Recurrent Pericarditis; Cardiac Magnetic Resonance Imaging

Evaluation and Treatment of Pericarditis

2015-10-13

Massimo Imazio , Fiorenzo Gaïta , Martin M. LeWinter

<h3>Importance</h3> Pericarditis is the most common form of pericardial disease and a relatively common cause of chest pain. <h3>Objective</h3> To summarize published evidence on the causes, diagnosis, therapy, prevention, and … <h3>Importance</h3> Pericarditis is the most common form of pericardial disease and a relatively common cause of chest pain. <h3>Objective</h3> To summarize published evidence on the causes, diagnosis, therapy, prevention, and prognosis of pericarditis. <h3>Evidence Review</h3> A literature search of BioMedCentral, Google Scholar, MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews was performed for human studies without language restriction from January 1, 1990, to August 31, 2015. After literature review and selection of meta-analyses, randomized clinical trials, and large observational studies, 30 studies (5 meta-analyses, 10 randomized clinical trials, and 16 cohort studies) with 7569 adult patients were selected for inclusion. <h3>Findings</h3> The etiology of pericarditis may be infectious (eg, viral and bacterial) or noninfectious (eg, systemic inflammatory diseases, cancer, and post–cardiac injury syndromes). Tuberculosis is a major cause of pericarditis in developing countries but accounts for less than 5% of cases in developed countries, where idiopathic, presumed viral causes are responsible for 80% to 90% of cases. The diagnosis is based on clinical criteria including chest pain, a pericardial rub, electrocardiographic changes, and pericardial effusion. Certain features at presentation (temperature >38°C [>100.4°F], subacute course, large effusion or tamponade, and failure of nonsteroidal anti-inflammatory drug [NSAID] treatment) indicate a poorer prognosis and identify patients requiring hospital admission. The most common treatment for idiopathic and viral pericarditis in North America and Europe is NSAID therapy. Adjunctive colchicine can ameliorate the initial episode and is associated with approximately 50% lower recurrence rates. Corticosteroids are a second-line therapy for those who do not respond, are intolerant, or have contraindications to NSAIDs and colchicine. Recurrences may occur in 30% of patients without preventive therapy. <h3>Conclusions and Relevance</h3> Pericarditis is the most common form of pericardial disease worldwide and may recur in as many as one-third of patients who present with idiopathic or viral pericarditis. Appropriate triage and treatment with NSAIDs may reduce readmission rates for pericarditis. Treatment with colchicine can reduce recurrence rates.

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Feigenbaum's Echocardiography

2010-09-26

Surya M. Artham

Consecutive 1127 Therapeutic Echocardiographically Guided Pericardiocenteses: Clinical Profile, Practice Patterns, and Outcomes Spanning 21 Years

2002-05-01

Teresa S.M. Tsang , Maurice Enriquez‐Sarano , William K. Freeman +5 more

The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study.

1984-03-01

L B Weitzman , W P Tinker , I Kronzon +3 more

One hundred twenty-two consecutive patients (104 men; 18 women) were studied to determine the incidence and natural history of pericardial effusion occurring 2, 5, 10, and 20 to 50 days … One hundred twenty-two consecutive patients (104 men; 18 women) were studied to determine the incidence and natural history of pericardial effusion occurring 2, 5, 10, and 20 to 50 days after cardiac surgery. Three patients had pericardial effusions before and 103 patients (91 men; three women) had effusions after surgery. Effusions were first recorded on the second postoperative day in 72 patients, on the fifth postoperative day in 29 patients, and on the tenth postoperative day in two patients. In 96 of these patients, effusions reached their maximum size by postoperative day 10. Of the 103 patients with effusions, 66 (64%) were followed to complete resolution. A specific pattern was observed in most resolving effusions. The echo-free space diagnostic of pericardial effusion became progressively more echo-dense as the effusion diminished in size. As the effusion became echo-dense, the posterior pericardium, which had been motionless, resumed its normal systolic anterior motion. One patient developed cardiac tamponade on postoperative day 3. We conclude that pericardial effusion occurs frequently after cardiac surgery, but that associated complications are rare.

Treatment of Malignant Pericardial Effusion

1994-07-06

Paul T. Vaitkus

<h3>Objective.</h3> —To discuss the diagnosis and treatment of malignant pericardial Objective.—To fusion and focus on quantitating the success and complication rates of the many treatment modalities and updating recent advances … <h3>Objective.</h3> —To discuss the diagnosis and treatment of malignant pericardial Objective.—To fusion and focus on quantitating the success and complication rates of the many treatment modalities and updating recent advances in the field. <h3>Data Sources.</h3> —English-language publications were identified by a computerized search (MEDLINE) of these key words:<i>cancer, tumor, malignancy, pericardium</i>, and<i>pericardial effusion</i>. This computerized search was supplemented by a manual search of the bibliographies of original research articles and textbooks. <h3>Study Selection.</h3> —Studies were included if the outcome of patients undergoing treatment for malignant pericardial effusion was reported separately from the outcome of patients with other causes of pericardial effusions. Studies that only reported the combined results of patients with malignant and nonmalignant effusions were excluded. <h3>Data Extraction.</h3> —To determine success rates for the various treatment modalities, we examined freedom from symptomatic recurrence of pericardial effusion requiring reintervention as the key end point. Where appropriate, we also examined procedural mortality rates. <h3>Results.</h3> —Initial relief of symptoms is achieved in most cases with percutaneous pericardiocentesis that, with echocardiographic guidance, can be performed with low morbidity and mortality. In many cases, drainage for several days with an indwelling catheter alleviates the effusion without subsequent recurrence. Systemic antitumor therapy with chemotherapy or radiation therapy is effective in controlling malignant effusions in cases of sensitive tumors such as lymphomas, leukemias, and breast cancer. Local sclerotherapy with tetracycline hydrochloride or bleomycin sulfate is also effective and associated with low morbidity. Sclerotherapy with other agents or radionuclides offers no advantages. Of the several surgical options, subxiphoid pericardiotomy has the advantage of low morbidity and mortality, can often be performed under local anesthesia, and is highly effective in preventing recurrence. Percutaneous balloon pericardiotomy has recently been described. This intervention is performed with local anesthesia, is effective in preventing reaccumulation, and has a low morbidity. <h3>Conclusions.</h3> —Treatment of malignant pericardial effusions must be individualized with consideration given to the patient's condition and tumor type, the success rates and risks of the various modalities, and local availability and expertise. (<i>JAMA</i>. 1994;272:59-64)

Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade.

1983-08-01

Linda D. Gillam , David E. Guyer , Tracey Gibson +3 more

The relationship of right atrial inversion, a previously undescribed cross-sectional echocardiographic sign, to the presence of cardiac tamponade was examined. We studied 127 patients with moderate or large pericardial effusions. … The relationship of right atrial inversion, a previously undescribed cross-sectional echocardiographic sign, to the presence of cardiac tamponade was examined. We studied 127 patients with moderate or large pericardial effusions. Cardiac tamponade was present in 19 and absent in 104. Four patients with equivocal tamponade were excluded from analysis. Right atrial inversion was present in 19 of 19 patients with cardiac tamponade and 19 of 104 without cardiac tamponade (sensitivity, 100%; specificity, 82%; predictive value, 50%). The degree of inversion as quantitated by the area-corrected curvature did not improve the ability to discriminate between patients with and without cardiac tamponade. However, consideration of the duration of inversion by the right atrial inversion time index (duration of inversion/cardiac cycle length) and an empirically derived cut-off of 0.34 did improve the specificity and predictive value (100% and 100%, respectively) without a significant loss of sensitivity (94%). We conclude that right atrial inversion, particularly if prolonged, is a useful echocardiographic marker of cardiac tamponade that may be of particular diagnostic value when the clinical picture is unclear.

Primary acute pericardial disease: A prospective series of 231 consecutive patients

1985-10-01

G. Permanyer‐Miralda , Jaume Sagristà-Sauleda , Jordi Soler‐Soler

Clinical clues to the causes of large pericardial effusions

2000-08-01

Jaume Sagristà-Sauleda , Jordi Mercé , Gaietà Permanyer-Miralda +1 more

Indicators of Poor Prognosis of Acute Pericarditis

2007-05-15

Massimo Imazio , Enrico Cecchi , Brunella Demichelis +7 more

The clinical search for indicators of poor prognosis of acute pericarditis may be useful for clinical triage of patients at high risk of specific causal conditions or complications. The aim … The clinical search for indicators of poor prognosis of acute pericarditis may be useful for clinical triage of patients at high risk of specific causal conditions or complications. The aim of the present article is to assess the relationship between clinical features at presentation and specific causes or complications.A total of 453 patients aged 17 to 90 years (mean age 52+/-18 years, 245 men) with acute pericarditis (post-myocardial infarction pericarditis was excluded) were prospectively evaluated from January 1996 to August 2004. A specific cause was found in 76 of 453 patients (16.8%): autoimmune in 33 patients (7.3%), neoplastic in 23 patients (5.1%), tuberculous in 17 patients (3.8%), and purulent in 3 patients (0.7%). In multivariable analysis, women (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.03 to 2.70; P=0.036) and patients with fever >38 degrees C (HR 3.56, 95% CI 1.82 to 6.95; P<0.001), subacute course (HR 3.97, 95% CI 1.66 to 9.50; P=0.002), large effusion or tamponade (HR 2.15, 95% CI 1.09 to 4.23; P=0.026), and failure of aspirin or of nonsteroidal anti-inflammatory drugs (HR 2.50, 95% CI 1.28 to 4.91; P=0.008) were at increased risk of specific causal conditions. After a mean follow-up of 31 months, complications were detected in 95 patients (21.0%): recurrences in 83 patients (18.3%), tamponade in 14 patients (3.1%), and constriction in 7 patients (1.5%). In multivariable analysis, women (HR 1.65, 95% CI 1.08 to 2.52; P=0.020) and patients with large effusion or tamponade (HR 2.51, 95% CI 1.37 to 4.61; P=0.003) and failure of aspirin or of nonsteroidal anti-inflammatory drugs (HR 5.50, 95% CI 3.56 to 8.51; P<0.001) were at increased risk of complications.Specific clinical features (fever >38 degrees C, subacute course, large effusion or tamponade, and aspirin or NSAID failure) may be useful to identify higher risk of specific causal conditions and complications.

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The common and distinct target genes of the p53 family transcription factors

2004-04-01

Kelly L. Harms , Susan E. Nozell , X. Chen

CT and MR Imaging of Pericardial Disease

2003-10-01

Zhen J. Wang , Gautham P. Reddy , Michael B. Gotway +3 more

In the evaluation of pericardial disease, computed tomography (CT) and magnetic resonance (MR) imaging traditionally have been used as adjuncts to echocardiography. However, CT and MR imaging are particularly useful … In the evaluation of pericardial disease, computed tomography (CT) and magnetic resonance (MR) imaging traditionally have been used as adjuncts to echocardiography. However, CT and MR imaging are particularly useful as sensitive and noninvasive methods for evaluating loculated or hemorrhagic pericardial effusion, constrictive pericarditis, and pericardial masses. Both CT and MR imaging provide excellent delineation of the pericardial anatomy and can aid in the precise localization and characterization of various pericardial lesions, including effusion, constrictive pericarditis and pericardial thickening, pericardial masses, and congenital anomalies such as partial or complete absence of the pericardium. Both modalities provide a larger field of view than does echocardiography, allowing the examination of the entire chest and detection of associated abnormalities in the mediastinum and lungs. Soft-tissue contrast on CT scans and MR images also is superior to that on echocardiograms. Given the many potential applications of these modalities in the evaluation of pericardial diseases, familiarity with the CT and MR imaging features of these diseases is important. © RSNA, 2003

Colchicine for Recurrent Pericarditis (CORP)

2011-10-04

Massimo Imazio

Background: Recurrence is the most common complication of pericarditis, affecting 10% to 50% of patients. Objective: To evaluate the efficacy and safety of colchicine for the secondary prevention of recurrent … Background: Recurrence is the most common complication of pericarditis, affecting 10% to 50% of patients. Objective: To evaluate the efficacy and safety of colchicine for the secondary prevention of recurrent pericarditis. Design: Prospective, randomized, double-blind, placebo-controlled multicenter trial. (ClinicalTrials.gov registration number: NCT00128414) Setting: 4 general hospitals in urban areas of Italy. Patients: 120 patients with a first recurrence of pericarditis. Intervention: In addition to conventional treatment, patients were randomly assigned to receive either placebo or colchicine, 1.0 to 2.0 mg on the first day followed by a maintenance dose of 0.5 to 1.0 mg/d, for 6 months. Measurements: The primary study end point was the recurrence rate at 18 months. Secondary end points were symptom persistence at 72 hours, remission rate at 1 week, number of recurrences, time to first recurrence, disease-related hospitalization, cardiac tamponade, and rate of constrictive pericarditis. Results: At 18 months, the recurrence rate was 24% in the colchicine group and 55% in the placebo group (absolute risk reduction, 0.31 [95% CI, 0.13 to 0.46]; relative risk reduction, 0.56 [CI, 0.27 to 0.73]; number needed to treat, 3 [CI, 2 to 7]). Colchicine reduced the persistence of symptoms at 72 hours (absolute risk reduction, 0.30 [CI, 0.13 to 0.45]; relative risk reduction, 0.56 [CI, 0.27 to 0.74]) and mean number of recurrences, increased the remission rate at 1 week, and prolonged the time to subsequent recurrence. The study groups had similar rates of side effects and drug withdrawal. Limitation: Multiple recurrences and neoplastic or bacterial causes were excluded. Conclusion: Colchicine is safe and effective for secondary prevention of recurrent pericarditis. Primary Funding Source: Maria Vittoria Hospital, Torino, Italy.

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The hemodynamics of cardiac tamponade and constrictive pericarditis

1970-11-01

Ralph Shabetai , Noble O. Fowler , Warren G. Guntheroth

Constrictive pericarditis and restrictive cardiomyopathy: evaluation with MR imaging.

1992-02-01

Takayuki Masui , Sanford J. Finck , C B Higgins

Twenty-nine patients who were referred with the possible diagnosis of constrictive pericarditis underwent electrocardiographically gated transverse spin-echo magnetic resonance (MR) imaging to determine the accuracy of spin-echo MR imaging for … Twenty-nine patients who were referred with the possible diagnosis of constrictive pericarditis underwent electrocardiographically gated transverse spin-echo magnetic resonance (MR) imaging to determine the accuracy of spin-echo MR imaging for the diagnosis of constrictive pericarditis and to compare the morphologic features of constrictive pericarditis with those of restrictive cardiomyopathy as seen on spin-echo MR images. Constrictive pericarditis was verified by means of surgery and/or catheterization in 17 patients. The sensitivity, specificity, and accuracy of MR imaging in the diagnosis of constrictive pericarditis were 88%, 100%, and 93%, respectively. Thickened pericardium was observed in 88% of patients with proved constrictive pericarditis. Pericardial thickening was not identified in patients with restrictive myocarditis (n = 4). The most frequent site of pericardial thickening was over the right ventricle. In constrictive pericarditis, the signal intensity of the thickened pericardium was similar or decreased compared with that of the myocardium. Indirect findings of impaired right ventricular diastolic filling (eg, dilatation of the inferior vena cava and right atrium) were identified in constrictive pericarditis and restrictive cardiomyopathy. MR imaging can serve as a noninvasive examination for the definitive diagnosis of constrictive pericarditis and can help distinguish between constrictive pericarditis and restrictive cardiomyopathy on the basis of pericardial thickness.

Cardiac tamponade and pericardial effusion: Respiratory variation in transvalvular flow velocities studied by Doppler echocardiography

1988-05-01

Christopher P. Appleton , Liv K. Hatle , Richard L. Popp

Cardiac tamponade in medical patients.

1981-09-01

B Guberman , N O Fowler , Peter J. Engel +2 more

We reviewed the cases of 56 medical patients wih cardiac tamponade who were treated at the University of Cincinnati. A paradoxic arterial pulse was critical in the diagnosis because most … We reviewed the cases of 56 medical patients wih cardiac tamponade who were treated at the University of Cincinnati. A paradoxic arterial pulse was critical in the diagnosis because most patients did not have a small quiet heart, and blood pressure was often well maintained. Fifty-two of 55 patients had enlarged cardiac silhouette by chest radiogram; heart sounds were diminished in 19 patients; arterial systolic pressure was greater than or equal to 100 mm Hg in 35, and arterial pulse pressure was greater than or equal to 40 mm Hg in 27. Echocardiograms in 23 patients showed abnormally increased right ventricular dimensions and decreased left ventricular dimensions during inspiration, except in one patient with left ventricular dysfunction. The causes of cardiac tamponade were metastatic tumor in 18 patients, idiopathic pericarditis in eight and uremia in five; five cases of tamponade occurred after heparin administration in acute cardiac infarction. Myxedema and dissecting aneurysm each caused tamponade in two patients. Pericardiocentesis relieved tamponade initially in 40 of 46 patients; however, two suffered fatal complications. Pericardial resection was done in 18, including 12 of these 46.

Differentiation of constrictive pericarditis from restrictive cardiomyopathy: Assessment of left ventricular diastolic velocities in longitudinal axis by doppler tissue imaging

1996-01-01

Mario J. Garcia , Leonardo Rodríguez , Miguel Ares +3 more

We sought to determine the utility of left ventricular expansion velocities in differentiating constrictive pericarditis from restrictive cardiomyopathy. Several studies have shown that left ventricular diastolic expansion is influenced by … We sought to determine the utility of left ventricular expansion velocities in differentiating constrictive pericarditis from restrictive cardiomyopathy. Several studies have shown that left ventricular diastolic expansion is influenced by the elastic recoil forces of the myocardium. These forces are affected by intrinsic myocardial disease but should be preserved when diastole is impaired as a result of extrinsic causes. Using Doppler tissue imaging, we measured peak early velocity of longitudinal axis expansion (Ea) in 8 patients with constrictive pericarditis, 7 patients with restriction and 15 normal volunteers. Transmitral early (E) and late (A) Doppler flow velocities, left ventricular systolic and diastolic volumes, ejection fraction and mitral annular M-mode displacement were also compared between the groups. The Eavalue was significantly higher in normal subjects (14.5 ± 4.7 cm/s [mean ±SD]) and in patients with constriction (14.8 ± 4.8 cm/s) than in those with restriction (5.1 ± 1.4 cm/s, p < 0.001 constriction vs. restriction). There was weak correlation between Eaand the extent of annular displacement (r = 0.55, p = 0.004) and the E/A ratio (r = 0.44, p = 0.03). There was no correlation between Eaand E (r = 0.33, p = 0.07) or ejection fraction (r = 0.21, p = 0.26). By multivariate analysis, Eawas the best variable for differentiating constriction from restriction. Our study indicates that longitudinal axis expansion velocities are markedly reduced in patients with restrictive cardiomyopathy. The poor correlation found with transvalvular flow velocities suggests that Eamay be relatively preload independent. The measurement of longitudinal axis expansion velocities provides a clinically useful distinction between constrictive pericarditis and restrictive cardiomyopathy and may prove to be valuable in the study of diastolic function.

Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography.

1989-02-01

L K Hatle , C. P. Appleton , Richard L. Popp

Doppler ultrasound recordings of mitral, tricuspid, aortic, and pulmonary flow velocities, and their variation with respiration, were recorded in 12 patients with a restrictive cardiomyopathy and seven patients with constrictive … Doppler ultrasound recordings of mitral, tricuspid, aortic, and pulmonary flow velocities, and their variation with respiration, were recorded in 12 patients with a restrictive cardiomyopathy and seven patients with constrictive pericarditis. Twenty healthy adults served as controls. The patients with constrictive pericarditis showed marked changes in left ventricular isovolumic relaxation time and in early mitral and tricuspid flow velocities at the onset of inspiration and expiration. These changes disappeared after pericardiectomy and were not seen in patients with restrictive cardiomyopathy or in normal subjects. The deceleration time of early mitral and tricuspid flow velocity was shorter than normal in both groups, indicating an early cessation of ventricular filling, but only patients with restrictive cardiomyopathy showed a further shortening of the tricuspid deceleration time with inspiration. Diastolic mitral and tricuspid regurgitation was also more common in the patients with restrictive cardiomyopathy. These results suggest that patients with constrictive pericarditis and restrictive cardiomyopathy can be differentiated by comparing respiratory changes in transvalvular flow velocities. In addition, although baseline hemodynamics in the two groups were similar, characteristic changes were seen with respiration that suggest differentiation of these disease states may also be possible from hemodynamic data.

Effusive–Constrictive Pericarditis

2004-01-29

Jaume Sagristà-Sauleda , Juan Ángel , Antonio Sánchez +2 more

Effusive-constrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constriction, caused by the visceral pericardium. We conducted a prospective study of its … Effusive-constrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constriction, caused by the visceral pericardium. We conducted a prospective study of its clinical evolution and management.From 1986 through 2001, all patients with effusive-constrictive pericarditis were prospectively evaluated. Combined pericardiocentesis and cardiac catheterization were performed in all patients, and pericardiectomy was performed in those with persistent constriction. Follow-up ranged from 1 month to 15 years (median, 7 years).A total of 1184 patients with pericarditis were evaluated, 218 of whom had tamponade. Of these 218, 190 underwent combined pericardiocentesis and catheterization. Fifteen of these patients had effusive-constrictive pericarditis and were included in the study. All patients presented with clinical tamponade; however, concomitant constriction was recognized in only seven patients. At catheterization, all patients had elevated intrapericardial pressure (median, 12 mm Hg; interquartile range, 7 to 18) and elevated right atrial and end-diastolic right and left ventricular pressures. After pericardiocentesis, the intrapericardial pressure decreased (median value, -5 mm Hg; interquartile range, -5 to 0), whereas right atrial and end-diastolic right and left ventricular pressures, although slightly reduced, remained elevated, with a dip-plateau morphology. The causes were diverse, and death was mainly related to the underlying disease. Pericardiectomy was required in seven patients, all of whom had involvement of the visceral pericardium. Three patients had spontaneous resolution.Effusive-constrictive pericarditis is an uncommon pericardial syndrome that may be missed in some patients who present with tamponade. Although evolution to persistent constriction is frequent, idiopathic cases may resolve spontaneously. In our opinion, extensive epicardiectomy is the procedure of choice in patients requiring surgery.

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Diagnostic role of Doppler echocardiography in constrictive pericarditis

1994-01-01

Jae K. Oh , Liv K. Hatle , James B. Seward +4 more

Purulent pericarditis: Review of a 20-year experience in a general hospital

1993-11-01

Jaume Sagristà-Sauleda , Jose A. Barrabés , G. Permanyer‐Miralda +1 more

Cardiac tamponade: hemodynamic observations in man.

1978-08-01

P S Reddy , E I Curtiss , J D O'Toole +1 more

Hemodynamic studies were performed before and after pericardiocentesis in 19 patients with pericardial effusion. Right atrial pressure decreases significantly, from 16 +/- 4 mm Hg (mean +/- SD) to 7 … Hemodynamic studies were performed before and after pericardiocentesis in 19 patients with pericardial effusion. Right atrial pressure decreases significantly, from 16 +/- 4 mm Hg (mean +/- SD) to 7 +/- 5 mm Hg in 14 patients with cardiac tamponade. This change was accompanied by significant increases in cardiac output (3.87 +/- 1.77 to 7 +/- 2.2 l/min) and inspiratory systemic arterial pulse pressure (45 +/- 29 to 81 +/- 23 mm Hg). The remaining five patients did not demonstrate cardiac tamponade, as evidenced by lack of significant change in these hemodynamic parameters. In all patients with tamponade, right ventricular end-diastolic pressure (RVEDP) was elevated and equal to pericardial pressure; equilibration was uniformly absent in patients without tamponade. During gradual fluid withdrawal in the tamponade group, significant hemodynamic improvement was largely confined to the period when right ventricular filling pressure remained equilibrated with pericardial pressure. In 10 patients with tamponade and pulsus paradoxus, pulmonary arterial wedge pressure (PAW) was equal to pericardial pressure except during early inspiration and expiration when it was transiently less and greater, respectively; however, inspiratory right atrial pressure never fell below pericardial pressure. In these 10 patients, PAW decreased significantly following pericardiocentesis (P less than 0.001). In the remaining four patients with tamponade but without pulsus paradoxus, all of whom had chronic renal failure, PAW was consistently higher than pericardial pressure or RVEDP and did not decrease after pericardiocentesis. These data tend to confirm the hypothesis that in patients with tamponade, the venous pressure required to maintain any given cardiac volume is determined by pericardial rather than ventricular compliance. When pericardial compliance determines diastolic pressure in both ventricles, relative filling of the ventricles will be competitive and determined by their respective venous pressures (pulmonary vs systemic), which vary with respiration and alternately favor right and left ventricular filling. This results in pulsus paradoxus. However, if pulmonary arterial wedge pressure is markedly elevated before the onset of tamponade, as in patients with chronic renal failure, then pericardial compliance may only determine right ventricular filling pressure. In such cases, pulsus paradoxus may be absent.

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Management of pericardial effusion

2012-11-02

Massimo Imazio , Yehuda Adler

Pericardial effusion is a common finding in clinical practice either as incidental finding or manifestation of a systemic or cardiac disease. The spectrum of pericardial effusions ranges from mild asymptomatic … Pericardial effusion is a common finding in clinical practice either as incidental finding or manifestation of a systemic or cardiac disease. The spectrum of pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade. The aetiology is varied (infectious, neoplastic, autoimmune, metabolic, and drug-related), being tuberculosis the leading cause of pericardial effusions in developing countries and all over the world, while concurrent HIV infection may have an important promoting role in this setting. Management is guided by the haemodynamic impact, size, presence of inflammation (i.e. pericarditis), associated medical conditions, and the aetiology whenever possible. Pericardiocentesis is mandatory for cardiac tamponade and when a bacterial or neoplastic aetiology is suspected. Pericardial biopsy is generally reserved for cases with recurrent cardiac tamponade or persistence without a defined aetiology, especially when a bacterial or neoplastic aetiology is suspected and cannot be assessed by other conventional and less invasive means. A true isolated effusion may not require a specific treatment if the patient is asymptomatic, but large ones are at risk of progression to cardiac tamponade (up to one third). Pericardiocentesis alone may be curative for large effusions, but recurrences are also common and pericardiectomy or less invasive options (i.e. pericardial window) should be considered with recurrent cardiac tamponade or symptomatic pericardial effusion (either circumferential or loculated). The aim of this paper was to summarize and critically evaluate current knowledge on the management of pericardial effusion.

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Ultrasound Diagnosis of Pericardial Effusion

1965-03-01

Harvey Feigenbaum

The differentiation between a large, dilated heart and pericardial effusion is essential but frequently difficult. The clinician must often resort to diagnostic procedures which offer some hazard to the patient. … The differentiation between a large, dilated heart and pericardial effusion is essential but frequently difficult. The clinician must often resort to diagnostic procedures which offer some hazard to the patient. The use of reflected ultrasound was found to be a highly effective and simple method of making this differential diagnosis. In five dogs with artificially produced pericardial effusion it was noted that without pericardial fluid only one ultrasound echo was produced in the vicinity of the posterior heart wall. When fluid was introduced, one detected two echoes, one which moved with cardiac action, the posterior heart wall, and another which moved only with respiration, the pericardium. The space between the two signals represented the pericardial fluid. Subsequent clinical studies confirmed the accuracy, reliability, and simplicity of this diagnostic procedure.

Pericardial Disease: Diagnosis and Management

2010-05-28

Masud H. Khandaker , Raúl E. Espinosa , Rick A. Nishimura +4 more

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Colchicine as First-Choice Therapy for Recurrent Pericarditis

2005-09-26

Massimo Imazio , Marco Bobbio , Enrico Cecchi +6 more

Colchicine seems to be a good drug for treating recurrences of pericarditis after conventional treatment failure, but no clinical trial has tested the effects of colchicine as first-line drug for … Colchicine seems to be a good drug for treating recurrences of pericarditis after conventional treatment failure, but no clinical trial has tested the effects of colchicine as first-line drug for the treatment of the first recurrence of pericarditis.A prospective, randomized, open-label design was used to investigate the safety and efficacy of colchicine therapy as adjunct to conventional therapy for the first episode of recurrent pericarditis. Eighty-four consecutive patients with a first episode of recurrent pericarditis were randomly assigned to receive conventional treatment with aspirin alone or conventional treatment plus colchicine (1.0-2.0 mg the first day and then 0.5-1.0 mg/d for 6 months). When aspirin was contraindicated, prednisone (1.0-1.5 mg/kg daily) was given for 1 month and then was gradually tapered. The primary end point was the recurrence rate. Intention-to-treat analyses were performed by treatment group.During 1682 patient-months (mean follow-up, 20 months), treatment with colchicine significantly decreased the recurrence rate (actuarial rates at 18 months were 24.0% vs 50.6%; P = .02; number needed to treat = 4.0; 95% confidence interval 2.5-7.1) and symptom persistence at 72 hours (10% vs 31%; P = .03). In multivariate analysis, previous corticosteroid use was an independent risk factor for further recurrences (odds ratio, 2.89; 95% confidence interval, 1.10-8.26; P = .04). No serious adverse effects were observed.Colchicine therapy led to a clinically important and statistically significant benefit over conventional treatment, decreasing the recurrence rate in patients with a first episode of recurrent pericarditis.

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Colchicine in Addition to Conventional Therapy for Acute Pericarditis

2005-09-26

Massimo Imazio , Marco Bobbio , Enrico Cecchi +7 more

Background— Colchicine is effective and safe for the treatment and prevention of recurrent pericarditis and might ultimately serve as the initial mode of treatment, especially in idiopathic cases. The aim … Background— Colchicine is effective and safe for the treatment and prevention of recurrent pericarditis and might ultimately serve as the initial mode of treatment, especially in idiopathic cases. The aim of this work was to verify the safety and efficacy of colchicine as an adjunct to conventional therapy for the treatment of the first episode of acute pericarditis. Methods and Results— A prospective, randomized, open-label design was used. A total of 120 patients (mean age 56.9±18.8 years, 54 males) with a first episode of acute pericarditis (idiopathic, viral, postpericardiotomy syndromes, and connective tissue diseases) were randomly assigned to conventional treatment with aspirin (group I) or conventional treatment plus colchicine 1.0 to 2.0 mg for the first day and then 0.5 to 1.0 mg/d for 3 months (group II). Corticosteroid therapy was restricted to patients with aspirin contraindications or intolerance. The primary end point was recurrence rate. During the 2873 patient-month follow-up, colchicine significantly reduced the recurrence rate (recurrence rates at 18 months were, respectively, 10.7% versus 32.3%; P =0.004; number needed to treat=5) and symptom persistence at 72 hours (respectively, 11.7% versus 36.7%; P =0.003). After multivariate analysis, corticosteroid use (OR 4.30, 95% CI 1.21 to 15.25; P =0.024) was an independent risk factor for recurrences. Colchicine was discontinued in 5 cases (8.3%) because of diarrhea. No serious adverse effects were observed. Conclusions— Colchicine plus conventional therapy led to a clinically important and statistically significant benefit over conventional treatment, decreasing the recurrence rate in patients with a first episode of acute pericarditis. Corticosteroid therapy given in the index attack can favor the occurrence of recurrences.

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Guidelines on the Diagnosis and Management of Pericardial Diseases Executive SummaryThe Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology

2004-04-01

Bernhard Maisch , Petar M. Seferovic' , Arsen Ristić +6 more

Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular … Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure.They should be helpful in everyday clinical decision-making.A great number of Guidelines and Expert Consensus Documents have been issued in recent years by different organisations, the European Society of Cardiology (ESC) and by other related societies.By means of links to web sites of National Societies several hundred guidelines are available.This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decisionmaking process.This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents.In spite of the fact that standards for issuing good quality Guidelines and Expert Consensus Documents are well defined, recent surveys of Guidelines and Expert Consensus Documents published in peer-reviewed journals between 1985 and 1998 have shown that methodological standards were not complied within the vast majority of cases.It is therefore of great importance that guidelines and recommendations are presented in formats that are easily interpreted.Subsequently, their implementation programmes must also be well conducted.Attempts have been made to determine whether guidelines improve the quality of clinical practice and the utilisation of health resources.The ESC Committee for Practice Guidelines (CPG) supervises and coordinates the preparation of new Guidelines and Expert Consensus Documents produced by Task Forces, expert groups or consensus panels.The Committee is also responsible for the endorsement of these Guidelines and Expert Consensus Documents or statements.

Risk of Constrictive Pericarditis After Acute Pericarditis

2011-08-16

Massimo Imazio , Antonio Brucato , Silvia Maestroni +4 more

Background— Constrictive pericarditis (CP) is considered a rare, dreaded possible complication of acute pericarditis. Nevertheless, there is a lack of prospective studies that have evaluated the specific risk according to … Background— Constrictive pericarditis (CP) is considered a rare, dreaded possible complication of acute pericarditis. Nevertheless, there is a lack of prospective studies that have evaluated the specific risk according to different etiologies. The aim of this study is to evaluate the risk of CP after acute pericarditis in a prospective cohort study with long-term follow-up. Methods and Results— From January 2000 to December 2008, 500 consecutive cases with a first episode of acute pericarditis (age, 51±16 years; 270 men) were prospectively studied to evaluate the evolution toward CP. Etiologies were viral/idiopathic in 416 cases (83.2%), connective tissue disease/pericardial injury syndromes in 36 cases (7.2%), neoplastic pericarditis in 25 cases (5.0%), tuberculosis in 20 cases (4.0%), and purulent in 3 cases (0.6%). During a median follow-up of 72 months (range, 24 to 120 months), CP developed in 9 of 500 patients (1.8%): 2 of 416 patients with idiopathic/viral pericarditis (0.48%) versus 7 of 84 patients with a nonviral/nonidiopathic etiology (8.3%). The incidence rate of CP was 0.76 cases per 1000 person-years for idiopathic/viral pericarditis, 4.40 cases per 1000 person-years for connective tissue disease/pericardial injury syndrome, 6.33 cases per 1000 person-years for neoplastic pericarditis, 31.65 cases for 1000 person-years for tuberculous pericarditis, and 52.74 cases per 1000 person-years for purulent pericarditis. Conclusions— CP is a relatively rare complication of viral or idiopathic acute pericarditis (<0.5%) but, in contrast, is relatively frequent for specific etiologies, especially bacterial.

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Colchicine for Prevention of Postpericardiotomy Syndrome and Postoperative Atrial Fibrillation

2014-08-30

Massimo Imazio , Antonio Brucato , Paolo Ferrazzi +7 more

InvestigatorsIMPORTANCE Postpericardiotomy syndrome, postoperative atrial fibrillation (AF), and postoperative effusions may be responsible for increased morbidity and health care costs after cardiac surgery.Postoperative use of colchicine prevented these complications in … InvestigatorsIMPORTANCE Postpericardiotomy syndrome, postoperative atrial fibrillation (AF), and postoperative effusions may be responsible for increased morbidity and health care costs after cardiac surgery.Postoperative use of colchicine prevented these complications in a single trial.OBJECTIVE To determine the efficacy and safety of perioperative use of oral colchicine in reducing postpericardiotomy syndrome, postoperative AF, and postoperative pericardial or pleural effusions. DESIGN, SETTING, AND PARTICIPANTSInvestigator-initiated, double-blind, placebo-controlled, randomized clinical trial among 360 consecutive candidates for cardiac surgery enrolled in 11 Italian centers between March 2012 and March 2014.At enrollment, mean age of the trial participants was 67.5 years (SD, 10.6 years), 69% were men, and 36% had planned valvular surgery.Main exclusion criteria were absence of sinus rhythm at enrollment, cardiac transplantation, and contraindications to colchicine.INTERVENTIONS Patients were randomized to receive placebo (n=180) or colchicine (0.5 mg twice daily in patients Ն70 kg or 0.5 mg once daily in patients <70 kg; n=180) starting between 48 and 72 hours before surgery and continued for 1 month after surgery. MAIN OUTCOMES AND MEASURESOccurrence of postpericardiotomy syndrome within 3 months; main secondary study end points were postoperative AF and pericardial or pleural effusion. RESULTSThe primary end point of postpericardiotomy syndrome occurred in 35 patients (19.4%) assigned to colchicine and in 53 (29.4%) assigned to placebo (absolute difference, 10.0%; 95% CI, 1.1%-18.7%;number needed to treat = 10).There were no significant differences between the colchicine and placebo groups for the secondary end points of postoperative AF (colchicine, 61 patients [33.9%]; placebo, 75 patients [41.7%]; absolute difference, 7.8%; 95% CI, -2.2% to 17.6%) or postoperative pericardial/pleural effusion (colchicine, 103 patients [57.2%]; placebo, 106 patients [58.9%]; absolute difference, 1.7%; 95% CI, -8.5% to 11.7%), although there was a reduction in postoperative AF in the prespecified on-treatment analysis (placebo, 61/148 patients [41.2%]; colchicine, 38/141 patients [27.0%]; absolute difference, 14.2%; 95% CI, 3.3%-24.7%).Adverse events occurred in 21 patients (11.7%) in the placebo group vs 36 (20.0%) in the colchicine group (absolute difference, 8.3%; 95% CI; 0.76%-15.9%;number needed to harm = 12), but discontinuation rates were similar.No serious adverse events were observed.CONCLUSIONS AND RELEVANCE Among patients undergoing cardiac surgery, perioperative use of colchicine compared with placebo reduced the incidence of postpericardiotomy syndrome but not of postoperative AF or postoperative pericardial/pleural effusion.The increased risk of gastrointestinal adverse effects reduced the potential benefits of colchicine in this setting.

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American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Pericardial Disease

2013-08-31

Allan L. Klein , Suhny Abbara , Deborah A. Agler +7 more

Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial

2014-03-30

Massimo Imazio , Riccardo Belli , Antonio Brucato +7 more

Sensitivity and Specificity of Echocardiographic Diagnosis of Pericardial Effusion

1974-08-01

Michael S. Horowitz , CLIFFORD S. SCHULTZ , Edward B. Stinson +2 more

In order to evaluate the reliability and sensitivity of echocardiograms for detecting and quantitating pericardial effusion, 41 patients had echocardiograms on the day prior to cardiac operation. A fluid trap … In order to evaluate the reliability and sensitivity of echocardiograms for detecting and quantitating pericardial effusion, 41 patients had echocardiograms on the day prior to cardiac operation. A fluid trap was used to aspirate the pericardium at operation. Thirty-nine of 41 patients had echocardiograms of diagnostic quality. In 25 patients, the echocardiogram was negative for pericardial effusion, with 0-16 ml identified at operation. In 13 patients, the echocardiogram was positive for pericardial effusion, with 15-775 ml aspirated at operation. A transition of patterns of relative posterior epicardial-pericardial movement was noted as the pericardial fluid volume increased. More than 15 ml was always found when a posterior echo-free space persisted throughout the cardiac cycle between a flat pericardium relative to the epicardium. In the presence of such a posterior echo-free space, a large anterior echo-free space made a moderately large pericardial effusion likely. In the absence of this diagnostic posterior echo-free space, an anterior echo-free space had no diagnostic significance, as it was found in 11 patients with less than 16 ml of pericardial effusion. A small posterior echo-free space persisting throughout the cardiac cycle between pericardial and epicardial echoes demonstrating virtually identical movements was found in two patients without any surgical evidence for pericardial effusion, but with evidence of adhesive fibrocalcific pericardial disease. A method of estimating pericardial volume is proposed, which uses the difference between the cubed diameters at the end-diastole of the pericardium and epicardium.

Metastatic Involvement of the Heart and Pericardium: CT and MR Imaging

2001-03-01

Caroline Chiles , Pamela K. Woodard , Fernando R. Gutiérrez +1 more

Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis. Tumors that are most likely to involve the … Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis. Tumors that are most likely to involve the heart and pericardium include cancers of the lung and breast, melanoma, and lymphoma. Tumor may involve the heart and pericardium by one of four pathways: retrograde lymphatic extension, hematogenous spread, direct contiguous extension, or transvenous extension. Metastatic involvement of the heart and pericardium may go unrecognized until autopsy. Impairment of cardiac function occurs in approximately 30% of patients and is usually attributable to pericardial effusion. The clinical presentation includes shortness of breath, which may be out of proportion to radiographic findings in patients with pericardial effusion or may be the result of associated pleural effusion. Patients may also present with cough, anterior thoracic pain, pleuritic chest pain, or peripheral edema. The differential diagnosis of pericardial effusion in a patient with known malignancy includes malignant pericardial effusion, radiation-induced pericarditis, drug-induced pericarditis, and idiopathic pericarditis. Any disease process that causes thickening or nodularity of the pericardium or myocardium or masses within the cardiac chambers can mimic metastatic disease.

Constrictive Pericarditis in 26 Patients With Histologically Normal Pericardial Thickness

2003-09-30

Deepak Talreja , William D. Edwards , Gordon K. Danielson +5 more

Background— Traditionally, increased pericardial thickness has been considered an essential diagnostic feature of constrictive pericarditis. Although constriction with a normal-thickness pericardium has been demonstrated clinically by noninvasive imaging, the details … Background— Traditionally, increased pericardial thickness has been considered an essential diagnostic feature of constrictive pericarditis. Although constriction with a normal-thickness pericardium has been demonstrated clinically by noninvasive imaging, the details of clinicopathological correlates have not been described. Methods and Results— A total of 143 patients with proven constriction underwent pericardiectomy at Mayo Clinic between 1993 and 1999. Their baseline characteristics, operative data, and pathological specimens were reviewed retrospectively. The pericardium was of normal thickness (≤2 mm) in 26 patients (18%; group 1) and was thickened (>2 mm) in 117 (82%; group 2). The most common causes of constriction in group 1 included previous cardiac surgery, chest irradiation, previous infarction, and idiopathic disease. There was little difference in symptoms and findings on physical examination between the 2 groups. Microscopically, no patient had an entirely normal pericardium. Histopathological abnormalities in group 1 were mild and focal, including fibrosis, inflammation, calcification, fibrin deposition, and focal noncaseating granulomas. Pericardiectomy was equally effective in relieving symptoms regardless of the presence or absence of increased thickness. Conclusions— Pericardial thickness was not increased in 18% of patients with surgically proven constrictive pericarditis, although the histopathological appearance was focally abnormal in all cases. When clinical, echocardiographic, or invasive hemodynamic features indicate constriction in patients with heart failure, pericardiectomy should not be denied on the basis of normal thickness as demonstrated by noninvasive imaging.

A Randomized Trial of Colchicine for Acute Pericarditis

2013-09-01

Massimo Imazio , Antonio Brucato , Roberto Cemin +7 more

Colchicine is effective for the treatment of recurrent pericarditis. However, conclusive data are lacking regarding the use of colchicine during a first attack of acute pericarditis and in the prevention … Colchicine is effective for the treatment of recurrent pericarditis. However, conclusive data are lacking regarding the use of colchicine during a first attack of acute pericarditis and in the prevention of recurrent symptoms.In a multicenter, double-blind trial, eligible adults with acute pericarditis were randomly assigned to receive either colchicine (at a dose of 0.5 mg twice daily for 3 months for patients weighing >70 kg or 0.5 mg once daily for patients weighing ≤70 kg) or placebo in addition to conventional antiinflammatory therapy with aspirin or ibuprofen. The primary study outcome was incessant or recurrent pericarditis.A total of 240 patients were enrolled, and 120 were randomly assigned to each of the two study groups. The primary outcome occurred in 20 patients (16.7%) in the colchicine group and 45 patients (37.5%) in the placebo group (relative risk reduction in the colchicine group, 0.56; 95% confidence interval, 0.30 to 0.72; number needed to treat, 4; P<0.001). Colchicine reduced the rate of symptom persistence at 72 hours (19.2% vs. 40.0%, P=0.001), the number of recurrences per patient (0.21 vs. 0.52, P=0.001), and the hospitalization rate (5.0% vs. 14.2%, P=0.02). Colchicine also improved the remission rate at 1 week (85.0% vs. 58.3%, P<0.001). Overall adverse effects and rates of study-drug discontinuation were similar in the two study groups. No serious adverse events were observed.In patients with acute pericarditis, colchicine, when added to conventional antiinflammatory therapy, significantly reduced the rate of incessant or recurrent pericarditis. (Funded by former Azienda Sanitaria Locale 3 of Turin [now Azienda Sanitaria Locale 2] and Acarpia; ICAP ClinicalTrials.gov number, NCT00128453.).

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Constrictive Pericarditis in the Modern Era

1999-09-28

Lieng H. Ling , Jae K. Oh , Hartzell V. Schaff +4 more

Background —The clinical spectrum of constrictive pericarditis (CP) has been affected by a change in incidence of etiological factors. We sought to determine the impact of these changes on the … Background —The clinical spectrum of constrictive pericarditis (CP) has been affected by a change in incidence of etiological factors. We sought to determine the impact of these changes on the outcome of pericardiectomy. Methods and Results —The contemporary spectrum of CP in 135 patients (76% male) evaluated at the Mayo Clinic from 1985 to 1995 was compared with that of a historic cohort. Notable trends were an increasing frequency of CP due to cardiac surgery and mediastinal radiation and presentation in older patients (median age, 61 versus 45 years). Perioperative mortality decreased (6% versus 14%, P =0.011), but late survival was inferior to that of an age- and sex-matched US population (57±8% at 10 years). The long-term outcome was predicted independently by 3 variables in stepwise logistic regression analyses: (1) age, (2) NYHA class, and most powerfully, (3) a postradiation cause. Of 90 late survivors in whom functional class could be determined, functional status had improved markedly (2.6±0.7 at baseline versus 1.5±0.8 at latest follow-up [ P <0.0001]), with 83% being free of clinical symptoms. Conclusions —The evolving profile of CP, with increasingly older patients and those with radiation-induced disease in the past decade, significantly affects postoperative prognosis. Long-term results of pericardiectomy are disappointing for some patient groups, especially those with radiation-induced CP. By contrast, surgery alleviates or improves symptoms in the majority of late survivors.

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Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis

1995-02-01

Ricardo Zayas , Manuel Anguita , Francisco Torres +6 more

Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy

2004-04-01

Stefan Bertog , Senthil Thambidorai , Kapil Parakh +7 more

Colchicine Reduces Postoperative Atrial Fibrillation

2011-11-17

Massimo Imazio , Antonio Brucato , Paolo Ferrazzi +7 more

Inflammation and pericarditis may be contributing factors for postoperative atrial fibrillation (POAF), and both are potentially affected by antiinflammatory drugs and colchicine, which has been shown to be safe and … Inflammation and pericarditis may be contributing factors for postoperative atrial fibrillation (POAF), and both are potentially affected by antiinflammatory drugs and colchicine, which has been shown to be safe and efficacious for the prevention of pericarditis and the postpericardiotomy syndrome (PPS). The aim of the Colchicine for the Prevention of the Post-Pericardiotomy Syndrome (COPPS) POAF substudy was to test the efficacy and safety of colchicine for the prevention of POAF after cardiac surgery.The COPPS POAF substudy included 336 patients (mean age, 65.7±12.3 years; 69% male) of the COPPS trial, a multicenter, double-blind, randomized trial. Substudy patients were in sinus rhythm before starting the intervention (placebo/colchicine 1.0 mg twice daily starting on postoperative day 3 followed by a maintenance dose of 0.5 mg twice daily for 1 month in patients ≥70 kg, halved doses for patients <70 kg or intolerant to the highest dose). The substudy primary end point was the incidence of POAF on intervention at 1 month. Despite well-balanced baseline characteristics, patients on colchicine had a reduced incidence of POAF (12.0% versus 22.0%, respectively; P=0.021; relative risk reduction, 45%; number needed to treat, 11) with a shorter in-hospital stay (9.4±3.7 versus 10.3±4.3 days; P=0.040) and rehabilitation stay (12.1±6.1 versus 13.9±6.5 days; P=0.009). Side effects were similar in the study groups.Colchicine seems safe and efficacious in the reduction of POAF with the potentiality of halving the complication and reducing the hospital stay.

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Acute Cardiac Tamponade

2003-08-14

David H. Spodick

Acute cardiac tamponade is life threatening and requires prompt pericardial drainage. This review explains the manifestations of tamponade, including a presentation in which the diagnostic finding of pulsus paradoxus is … Acute cardiac tamponade is life threatening and requires prompt pericardial drainage. This review explains the manifestations of tamponade, including a presentation in which the diagnostic finding of pulsus paradoxus is absent, and variant forms, such as low-pressure tamponade and regional tamponade.

Controversial Issues in the Management of Pericardial Diseases

2010-02-22

Massimo Imazio , David H. Spodick , Antonio Brucato +2 more

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Acute Pericarditis

2004-11-17

Richard A. Lange , L. David Hillis

A 35-year-old woman who is otherwise healthy has had constant retrosternal chest pain for two days. The pain worsens when she lies down and improves when she sits up and … A 35-year-old woman who is otherwise healthy has had constant retrosternal chest pain for two days. The pain worsens when she lies down and improves when she sits up and leans forward. On physical examination, the patient is afebrile and has a friction rub. The 12-lead electrocardiogram shows widespread ST-segment elevation and concomitant PR-segment depression. How should this patient be evaluated and treated?

2015 ESC Guidelines for the diagnosis and management of pericardial diseases

2015-08-29

Yehuda Adler , Philippe Charron , Massimo Imazio +7 more

The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their … The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication.The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies.Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver.Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations.It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

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Effect of Anakinra on Recurrent Pericarditis Among Patients With Colchicine Resistance and Corticosteroid Dependence

2016-11-08

Antonio Brucato , Massimo Imazio , Marco Gattorno +7 more

<h3>Importance</h3> Anakinra, an interleukin 1β recombinant receptor antagonist, may have potential to treat colchicine-resistant and corticosteroid-dependent recurrent pericarditis. <h3>Objective</h3> To determine the efficacy of anakinra for colchicine-resistant and corticosteroid-dependent recurrent … <h3>Importance</h3> Anakinra, an interleukin 1β recombinant receptor antagonist, may have potential to treat colchicine-resistant and corticosteroid-dependent recurrent pericarditis. <h3>Objective</h3> To determine the efficacy of anakinra for colchicine-resistant and corticosteroid-dependent recurrent pericarditis. <h3>Design, Setting, and Participants</h3> The Anakinra—Treatment of Recurrent Idiopathic Pericarditis (AIRTRIP) double-blind, placebo-controlled, randomized withdrawal trial (open label with anakinra followed by a double-blind withdrawal step with anakinra or placebo until recurrent pericarditis occurred) conducted among 21 consecutive patients enrolled at 3 Italian referral centers between June and November 2014 (end of follow-up, October 2015). Included patients had recurrent pericarditis (with ≥3 previous recurrences), elevation of C-reactive protein, colchicine resistance, and corticosteroid dependence. <h3>Interventions</h3> Anakinra was administered at 2 mg/kg per day, up to 100 mg, for 2 months, then patients who responded with resolution of pericarditis were randomized to continue anakinra (n = 11) or switch to placebo (n = 10) for 6 months or until a pericarditis recurrence. <h3>Main Outcomes and Measures</h3> The primary outcomes were recurrent pericarditis and time to recurrence after randomization. <h3>Results</h3> Eleven patients (7 female) randomized to anakinra had a mean age of 46.5 (SD, 16.3) years; 10 patients (7 female) randomized to placebo had a mean age of 44 (SD, 12.5) years. All patients were followed up for 12 months. Median follow-up was 14 (range, 12-17) months. Recurrent pericarditis occurred in 9 of 10 patients (90%; incidence rate, 2.06% of patients per year) assigned to placebo and 2 of 11 patients (18.2%; incidence rate, 0.11% of patients per year) assigned to anakinra, for an incidence rate difference of −1.95% (95% CI, −3.3% to −0.6%). Median flare-free survival (time to flare) was 72 (interquartile range, 64-150) days after randomization in the placebo group and was not reached in the anakinra group (<i>P</i> <.001). During anakinra treatment, 20 of 21 patients (95.2%) experienced transient local skin reactions: 1 (4.8%) herpes zoster, 3 (14.3%) transaminase elevation, and 1 (4.8%) ischemic optic neuropathy. No patient permanently discontinued the active drug. No adverse events occurred during placebo treatment. <h3>Conclusion and Relevance</h3> In this preliminary study of patients with recurrent pericarditis with colchicine resistance and corticosteroid dependence, the use of anakinra compared with placebo reduced the risk of recurrence over a median of 14 months. Larger studies are needed to replicate these findings as well as to assess safety and longer-term efficacy. <h3>Trial Registration</h3> clinicaltrials.gov Identifier:NCT02219828

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Management of Acute and Recurrent Pericarditis

2020-01-01

Juan Guido Chiabrando , Aldo Bonaventura , Alessandra Vecchié +7 more

Pericarditis

2004-02-01

Richard W. Troughton , Craig R. Asher , Allan L. Klein

Pericardial Disease

2006-03-27

William C. Little , Gregory L. Freeman

I n contrast to coronary artery disease, heart failure, valvular disease, and other topics in the field of cardiology, there are few data from randomized trials to guide physicians in … I n contrast to coronary artery disease, heart failure, valvular disease, and other topics in the field of cardiology, there are few data from randomized trials to guide physicians in the management of pericardial diseases.Although there are no American Heart Association/American College of Cardiology guidelines on this topic, the European Society of Cardiology has recently published useful guidelines for the diagnosis and management of pericardial diseases. 1Our review focuses on the current state of knowledge and the management of the most important pericardial diseases: acute pericarditis, pericardial tamponade, pericardial constriction, and effusive constrictive pericarditis.

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Tuberculous Pericarditis

2005-12-05

Bongani M. Mayosi , Lesley Burgess , Anton Doubell

The incidence of tuberculous pericarditis is increasing in Africa as a result of the human immunodeficiency virus (HIV) epidemic. The primary objective of this article was to review and summarize … The incidence of tuberculous pericarditis is increasing in Africa as a result of the human immunodeficiency virus (HIV) epidemic. The primary objective of this article was to review and summarize the literature on the pathogenesis, diagnosis, and management of tuberculous pericarditis.We searched MEDLINE (January 1966 to May 2005) and the Cochrane Library (Issue 1, 2005) for information on relevant references. A "definite" diagnosis of tuberculous pericarditis is based on the demonstration of tubercle bacilli in pericardial fluid or on a histological section of the pericardium; "probable" tuberculous pericarditis is based on the proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis, a lymphocytic pericardial exudate with elevated adenosine deaminase levels, and/or appropriate response to a trial of antituberculosis chemotherapy. Treatment consists of the standard 4-drug antituberculosis regimen for 6 months. It is uncertain whether adjunctive corticosteroids are effective in reducing mortality or progression to constriction. Surgical resection of the pericardium remains the appropriate treatment for constrictive pericarditis. The timing of surgical intervention is controversial, but many experts recommend a trial of medical therapy for noncalcific pericardial constriction, and pericardiectomy in nonresponders after 4 to 8 weeks of antituberculosis chemotherapy.Research is needed to improve the diagnosis, assess the effectiveness of adjunctive steroids, and determine the impact of HIV infection on the outcome of tuberculous pericarditis.

Consecutive 1127 Therapeutic Echocardiographically Guided Pericardiocenteses: Clinical Profile, Practice Patterns, and Outcomes Spanning 21 Years

2002-05-01

Teresa S.M. Tsang , Maurice Enriquez‐Sarano , William K. Freeman +5 more

Scores for Risk Stratification of Pericarditis

2025-06-24

Massimo Imazio , Alessandro Andreis , Allan L. Klein +3 more | Current Cardiology Reports

Comparative Efficacy and Safety of Colchicine and Anti–Interleukin‐1 Agents in Recurrent Pericarditis: A Pairwise and Network Meta‐Analysis of Randomized Controlled Trials

2025-06-23

Muhammad Ehsan , Alveena Batool Syed , Biah Mustafa +6 more | Journal of the American Heart Association

The management of recurrent pericarditis includes colchicine and anti-interleukin-1 agents, given the limited efficacy and adverse effects of NSAIDs and corticosteroids. We conducted a pairwise and network meta-analysis to evaluate … The management of recurrent pericarditis includes colchicine and anti-interleukin-1 agents, given the limited efficacy and adverse effects of NSAIDs and corticosteroids. We conducted a pairwise and network meta-analysis to evaluate the efficacy and safety of colchicine and anti-interleukin-1 agents in recurrent pericarditis. We conducted a comprehensive search on various databases to retrieve relevant randomized controlled trials. Pairwise meta-analyses were performed in R using the exact Mantel-Haenszel method. We also performed a network meta-analysis with a colchicine group as the comparator. A total of 6 randomized controlled trials were included in the meta-analysis. The risk of pericarditis recurrence was significantly decreased by colchicine (risk ratio [RR], 0.46 [95% CI, 0.37-0.58]) and anti-interleukin-1 agents (RR, 0.12 [95% CI, 0.03-0.54]) compared with placebo or standard therapy. Colchicine significantly decreased the risk of treatment failure (RR, 0.42 [95% CI, 0.31-0.57]) and pericarditis-related rehospitalization (RR, 0.26 [95% CI, 0.10-0.70]) but did not have a significant impact on the risk of adverse events (RR, 1.06 [95% CI, 0.31-3.62]). Anti-interleukin-1 agents were associated with a significantly increased risk of adverse events (RR, 1.88 [95% CI, 1.60-2.21]). The network meta-analysis showed that anti-interleukin-1 agents were associated with a greater reduction in pericarditis recurrence than colchicine (RR, 0.27 [95% CI, 0.11-0.67]), with no significant difference with respect to adverse events (RR, 1.77 [95% CI, 0.88-3.57]). Both colchicine and anti-interleukin-1 agents are effective in reducing the risk of recurrent pericarditis. Anti-interleukin-1 agents are associated with more frequent nonserious adverse events, but evidence on serious adverse events remains inconclusive.

A Case of Association of Coronavirus HKU-1 with Troponin Leakage Syndrome Presenting as a Case of Acute Coronary Syndrome

2025-06-23

Kartik Jadhav , Narasaraju Kavalipati , Syamala Nadiminty +3 more | Journal of Indian College of Cardiology

Abstract In the last five decades, human corona virus (CoVs) have been linked to upper respiratory tract infections such as the common cold. HKU-1 infection was first discovered in Hong … Abstract In the last five decades, human corona virus (CoVs) have been linked to upper respiratory tract infections such as the common cold. HKU-1 infection was first discovered in Hong Kong in 2014. Unlike other CoV strains, HKU-1 infection usually results in a moderate respiratory infection. The heart is rarely affected by HKU-1 infection. There have been a few cases of HKU-1 infection presenting as pericarditis and pericardial effusion. We present a case of CoV HKU-1 infection presenting with significant chest discomfort and high serial troponin-I levels, which was suspected to be acute coronary syndrome.

Incidence, risk factors and clinical outcomes of pericardial effusion in left ventricular assist device patients

2025-06-20

Mohammad Zubair Khan , Yevgeniy Brailovsky , Mohammad Alfrad Nobel Bhuiyan +7 more | World Journal of Cardiology

Development of pericardial effusion in patients with left ventricular assist devices (LVADs) can be detrimental to health outcomes. This study aims to elucidate the prevalence and risk factors for pericardial … Development of pericardial effusion in patients with left ventricular assist devices (LVADs) can be detrimental to health outcomes. This study aims to elucidate the prevalence and risk factors for pericardial effusion in patients with LVADs. To elucidate risk factors associated with the presence of pericardial effusion in patients with LVADs and compare the clinical outcomes of those with and without pericardial effusion. The secondary goal is to determine the incidence of pericardiocentesis and pericardial window placement in patients with LVADs experiencing pericardial effusion. Data were obtained from the National Inpatient Sample database between 2016 and 2018. Statistical analysis was performed using Pearson χ 2 test and multivariate logistic regression analysis to determine clinical outcomes of pericardial effusion and to identify variables associated with pericardial effusion in LVAD patients, respectively. The prevalence of LVAD was 9850 (0.01%) among total study patients (n = 98112095). The incidence of pericardial effusion among LVAD patients was 640 (6.5%). The prevalence of liver disease (26.6% vs 17.4%), chronic kidney disease (CKD; 54.6% vs 49.4%), hypothyroidism (21.9% vs 18.1%), congestive heart failure (98.4% vs 96.5%), atrial fibrillation (Afib; 58.59% vs 50.5%), coronary artery disease (CAD; 11.7% vs 4.4%), dyslipidemia (31.3% vs 39.3%), and having undergone percutaneous coronary intervention (PCI; 1.6% vs 0.7%) was higher in the pericardial effusion cohort vs the non-pericardial effusion cohort. Multivariate regression analysis demonstrated that CAD (OR = 2.89) and PCI (OR = 2.2) had the greatest association with pericardial effusion in patients with LVADs. These were followed by liver disease (OR = 1.72), hypothyroidism (OR = 1.2), electrolyte derangement (OR = 1.2), Afib (OR = 1.1), and CKD (OR = 1.05). Among patients with LVADs, the median length of stay (33 days vs 27 days) and hospitalization cost (847525 USD vs 792616 USD) were significantly higher in the pericardial effusion cohort compared to the non-pericardial effusion cohort. There was no significant difference in mortality between cohorts. The prevalence of cardiac tamponade was 109 (17.9% of LVAD patients with pericardial effusion). Ten (9.2% of LVAD patients with cardiac tamponade) patients underwent pericardiocentesis and 44 (40.3%) received a pericardial window. This study shows that liver disease, CKD, PCI, hypothyroidism, electrolyte derangement, Afib, and CAD had a significant association with pericardial effusion in LVAD patients. Hospitalization cost and length of stay were higher in the pericardial effusion group, but mortality was the same.

Douleur thoracique

2025-06-19

C. Hermand , Youri Yordanov | EMC - Traité de médecine AKOS

Cardiac tamponade as the initial presentation of t-cell lymphoblastic lymphoma in a young female: A case report

2025-06-19

G Silva , Fabiana Oliveira , Kelvin Henrique Vilalva +1 more | International Journal of Health Sciences

T-cell lymphoblastic lymphoma (T-LBL) is a rare and aggressive subtype of non-Hodgkin lymphoma. It often presents with mediastinal masses, but its initial manifestation with cardiac tamponade is exceedingly uncommon. We … T-cell lymphoblastic lymphoma (T-LBL) is a rare and aggressive subtype of non-Hodgkin lymphoma. It often presents with mediastinal masses, but its initial manifestation with cardiac tamponade is exceedingly uncommon. We report the case of a 24-year-old female presenting with progressive dyspnea due to large pericardial effusion with tamponade physiology, leading to the diagnosis of T-LBL. The patient underwent partial pericardiectomy followed by immunophenotyping that confirmed the diagnosis. Chemotherapy was initiated with favorable response. This case highlights the importance of considering lymphoma in young patients with unexplained pericardial effusion and emphasizes the need for prompt diagnostic workup.

Morbidity and Mortality with Pericardial Effusion Associated with Direct Oral Anticoagulants and P-glycoprotein Inhibitors

2025-06-19

Schwartz Jessica , Arquiette Jered , Vo Jack +3 more | Journal of Cardiology and Cardiovascular Medicine

Pericardial effusion is a rare but potentially fatal adverse effect reported with apixaban, dabigatran, edoxaban, and rivaroxaban (direct oral anticoagulants). We report three cases of pericardial effusion that occurred at … Pericardial effusion is a rare but potentially fatal adverse effect reported with apixaban, dabigatran, edoxaban, and rivaroxaban (direct oral anticoagulants). We report three cases of pericardial effusion that occurred at a single institution with two patients requiring urgent pericardiocentesis. All patients took a direct oral anticoagulant with a p-glycoprotein inhibitor or a combined p-glycoprotein and CYP3A4 inhibitor. Our patients had underlying conditions predisposing them to developing pericardial effusion.

PERICARDIOCENTESE DEVIDO À EFUSÃO PERICÁRDICA EM GOLDEN RETRIEVER: RELATO DE CASO

2025-06-15

Luciana Godoy , Liliana Costa , Elion Basilio Rodrigues Filho +7 more | Aracê.

This report describes a clinical case of pericardial effusion in a 5-year-old, 32-kg Golden Retriever dog that presented with exercise intolerance, progressive weakness, and episodes of syncope. Imaging tests, such … This report describes a clinical case of pericardial effusion in a 5-year-old, 32-kg Golden Retriever dog that presented with exercise intolerance, progressive weakness, and episodes of syncope. Imaging tests, such as chest radiography and echocardiography, confirmed the presence of pericardial effusion and cardiac tamponade. Pericardiocentesis was successfully performed, draining 252 mL of serosanguineous fluid, which resulted in significant clinical improvement within the first 24 hours. Given the possibility of recurrence, pericardiectomy was chosen and performed successfully, promoting the patient's complete recovery. This case highlights the importance of early diagnosis and the use of advanced methods, such as echocardiography, for the effective management of pericardial effusion and cardiac tamponade in dogs.

Recurrent Pericardial Syndromes Following Boerhaave’s Syndrome: A Complex Clinical Presentation and Case Report

2025-06-14

M Eltayeb , Luke Byrne , Gearoid Fitzgerald +1 more | European Heart Journal - Case Reports

Abstract Background Recurrent pericardial syndromes secondary to Boerhaave’s Syndrome (spontaneous oesophageal rupture) are exceedingly rare and represent diagnostic and therapeutic challenges. Case Summary We present a case of a 46-year-old … Abstract Background Recurrent pericardial syndromes secondary to Boerhaave’s Syndrome (spontaneous oesophageal rupture) are exceedingly rare and represent diagnostic and therapeutic challenges. Case Summary We present a case of a 46-year-old male with recurrent pericardial effusions and cardiac tamponade following Boerhaave’s Syndrome. Initial management included surgical repair of the oesophageal rupture and medical treatment for the subsequent effusions with colchicine, NSAIDs, and corticosteroids. The patient experienced multiple recurrences despite medical therapy, necessitating a multidisciplinary approach. Ultimately, a pericardiectomy was performed, revealing significant pericardial adhesions and inflammation. Post-operative recovery was uneventful with recurrence of effusion. Discussion This case underscores the importance of early recognition and multidisciplinary management in recurrent pericardial syndromes associated with oesophageal rupture. While first-line medical therapy can be effective, persistent or refractory cases may require surgical intervention. Early surgical consultation should be considered when medical management fails.

A Case of Colchicine Overdose and Toxicity

2025-06-13

Samir Parekh , Ty J Merry , Vanshika Tripathi +1 more | Cureus

Cardiac Tamponade in a Suspected COVID-19 Patient

2025-06-11

Gurpreet Singh | Cureus

Is It an Intrapericardial Mass or a Localized Pericardial Effusion? A Case Report of Tuberculous Pericarditis Evaluated by Multimodal Imaging

2025-06-04

Yang Han , Bingbing Liu , Yonghuai Wang +3 more | Journal of Clinical Ultrasound

ABSTRACT Tuberculous pericarditis is often difficult to diagnose because of atypical symptoms and insufficient etiology examination. We present a case wherein the patient initially presented with a high fever accompanied … ABSTRACT Tuberculous pericarditis is often difficult to diagnose because of atypical symptoms and insufficient etiology examination. We present a case wherein the patient initially presented with a high fever accompanied by recurrent pericardial effusion. Notably, the etiology and genetic diagnosis of tuberculosis were negative. With the combined application of multimodal imaging techniques such as transthoracic echocardiography, transesophageal echocardiography, contrast‐enhanced ultrasound and enhanced CT, clinical diagnosis and treatment can provide sufficient evidence to support tuberculous pericarditis. Following the definitive diagnosis, the patient received an adequate course of antituberculosis treatment, and the condition improved significantly, with no recurrence of symptoms.

Pericardial Decompression Syndrome

2025-06-01

Asaka Asakura , Takashi Honda , Manabu Takanashi +7 more | JACC Case Reports

Difficult-to-treat recurrent pericarditis after SARS-CoV-2 vaccination

2025-06-01

Michele Marchetta , Rosa Johanna Clavijo López , Michele Golino +2 more | International Journal of Cardiology

Perikarditis im Kindesalter

2025-06-01

Sebastian Frede , Matthias Gorenflo | Pädiatrie

Constrictive Pericarditis: Modern Causes of an Old Disease

2025-06-01

Hassan A. Gargoum | Libyan International Medical University Journal

Abstract This review examines the evolving landscape of constrictive pericarditis (CP) through analysis of literature spanning 1932 to 2025, sourced from PubMed, Scopus, and Google Scholar using key terms related … Abstract This review examines the evolving landscape of constrictive pericarditis (CP) through analysis of literature spanning 1932 to 2025, sourced from PubMed, Scopus, and Google Scholar using key terms related to the etiology, clinical features, diagnosis, and treatment of CP. Eligible literature included original research articles, systematic and narrative reviews, case reports, expert consensus statements, and guidelines from professional societies. CP is a chronic pericardial disease resulting in impaired ventricular filling and heart failure symptoms. While previously dominated by tuberculosis and idiopathic cases, its modern etiological profile has shifted significantly. This review explores the evolving causes, clinical features, diagnostic advances, and treatment strategies of CP in the current medical practice. Modern causes of CP include prior cardiac surgery/percutaneous intervention, radiation therapy, autoimmune diseases, viral pericarditis, and uremia associated with end-stage renal disease. Modern imaging modalities—particularly echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging—have improved diagnostic accuracy and helped differentiate CP from other causes of heart failure. Features such as pericardial late gadolinium enhancement and elevated inflammatory markers help identifying reversible subset of the disease, which may respond to anti-inflammatory therapy. In chronic, fibrotic cases, surgical pericardiectomy remains the definitive therapy, with outcomes improved by early diagnosis and appropriate timing of surgery. CP is no longer a relic of the past, but a dynamic condition shaped by modern medicine. Recognizing its evolving etiologies is critical for timely diagnosis and individualized treatment. With advances in imaging and inflammation-targeted therapies, opportunities exist to improve outcomes and reduce reliance on surgery in selected cases.

Conus Artery Injury During Radiofrequency-Assisted RAA Perforation for Pericardial CO2 Insufflation

2025-06-01

Koji Higuchi , Mohammad Abbasi , Eric E. Roselli +2 more | JACC. Clinical electrophysiology

KONSTRIKCINIS PERIKARDITAS: ETIOLOGIJA, EPIDEMIOLOGIJA IR PATOFIZIOLOGIJA

2025-06-01

Greta Žaldokaitė | Health Sciences

Konstrikcinis perikarditas yra reta uždegiminė liga, kuriai būdingas perikardo randėjimas, fibrozė ir kalcifikacija, nulemianti diastolinę disfunkciją, dėl kurios atsiranda mažas širdies tūris ir išsivysto širdies nepakankamumas. Vakarų pasaulyje dažniausi konstrikcinio … Konstrikcinis perikarditas yra reta uždegiminė liga, kuriai būdingas perikardo randėjimas, fibrozė ir kalcifikacija, nulemianti diastolinę disfunkciją, dėl kurios atsiranda mažas širdies tūris ir išsivysto širdies nepakankamumas. Vakarų pasaulyje dažniausi konstrikcinio perikardito etiologiją lemiantys veiksniai yra idiopatinė eiga, virusinė infekcija, kardiochirurginės operacijos bei tarpuplaučio spindulinis gydymas. Besivystančiose šalyse pagrindinė konstrikcinio perikardito priežastis yra tuberkuliozė. Konstrikciniu perikarditu dažniau serga vyrai nei moterys.

Clozapine Induced Pericarditis: A Systematic Review

2025-06-01

Aliu O Yakubu , Olorungbami K Anifalaje , Moses Effiong +2 more | BJPsych Open

Aims: Clozapine is an atypical antipsychotic for treatment-resistant schizophrenia. Despite its efficacy, there are potential life-threatening side effects, including pericarditis, which has limited its usage. Clozapine-induced pericarditis may range from … Aims: Clozapine is an atypical antipsychotic for treatment-resistant schizophrenia. Despite its efficacy, there are potential life-threatening side effects, including pericarditis, which has limited its usage. Clozapine-induced pericarditis may range from mild symptoms to life-threatening complications. Despite increasing case reports, a comprehensive synthesis is lacking, necessitating a systematic review. Methods: A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO. Eight databases, including PubMed, Embase, and PsycINFO, were searched, identifying case reports published between 1980 and 2024. Inclusion criteria focused on English-language case reports diagnosing clozapine-induced pericarditis. Exclusion criteria included non-clozapine-induced pericarditis and mixed aetiologies without clozapine-specific data. Data extraction included demographics, clinical presentation, diagnostic findings, management, and outcomes. Results: Of the 941 identified articles, 36 met the inclusion criteria. The mean age was 33.56 years (SD: 15.56), with males comprising 63.9%. Chest pain (63.8%), fever (52.8%), breathlessness (50%), and tachycardia (44.4%) were the most common symptoms. Diagnostic tests consistently indicated elevated inflammatory markers, including CRP (mean: 88.13 mg/dL) and ESR (mean: 72.72 mm/hr). Echocardiograms confirmed pericardial effusion in 88.9% of cases. Management strategies included colchicine (16.7%) and analgesics (19.4%), with cardiac recovery achieved in all but one case. Clozapine rechallenge was attempted in 16.7%, with successful outcomes in 83.3% of these cases. Time to recovery averaged 3.73 weeks (SD: 9.8). Psychiatric stability was maintained in most cases following substitution with alternative antipsychotics, primarily olanzapine and risperidone. Conclusion: Clozapine-induced pericarditis is a rare but significant adverse event characterized by elevated inflammatory markers and diagnostic imaging abnormalities. Prompt recognition and tailored management, including anti-inflammatory treatment and careful rechallenge, can lead to favourable cardiac and psychiatric outcomes. This review underscores the need for heightened clinician awareness and standardized protocols to optimize care for patients requiring clozapine therapy.

Congestión refractaria tras pericardiocentesis efectiva en un taponamiento cardiaco: pericarditis efusivoconstrictiva por Cutibacterium acnes

2025-06-01

Meritxell Santaló-Corcoy , Laura Triguero-Llonch , Juan Fernández-Martínez +3 more | Revista Española de Cardiología

PERICARDIAL EFFUSION SECONDARY TO SEVERE HYPOTHYROIDISM IN DOWN’S SYNDROME

2025-05-30

Mohd Fit’ri Akmal Mohd Sofee , Nurshadia Samingan , Lalrawngbawli Annie +3 more | Journal of the ASEAN Federation of Endocrine Societies

INTRODUCTIONHypothyroidism is a recognized cause of pericardial effusion. Among children with Down’s syndrome, hypothyroidism may be an associated feature. METHODOLOGYWe report a case of a 4-year-old female with Down’s syndrome … INTRODUCTIONHypothyroidism is a recognized cause of pericardial effusion. Among children with Down’s syndrome, hypothyroidism may be an associated feature. METHODOLOGYWe report a case of a 4-year-old female with Down’s syndrome and severe pericardial effusion secondary to hypothyroidism. She was born with no history of maternal thyroid disease. The diagnosis of Down’s syndrome was made postnatally. She was diagnosed with congenital hypothyroidism and was started on treatment during her stormy neonatal period. She had a recurrent lung infection, developed chronic lung disease and worsening pulmonary hypertension. Due to multiple hospital admissions, she was non-compliant to her thyroid medications. She has been asymptomatic apart from failure to grow and mild constipation which was attributed to poor nutrition and presumed gastroesophageal reflux disease. At the age of 3 years and 6 months, she was noted to have muffled heart sounds. Her vitals were normal for age, but ECG showed a relative bradycardia with a rate of 65 bpm with low voltage and flattening of the T-wave. Her echocardiogram showed large pericardial effusion. Her thyroid-stimulating hormone (TSH) was 1085.52 mIU/L and free thyroxine (FT4) of <1.3 pmol/L, confirming severe hypothyroidism. She was started on intravenous levothyroxine for five days before changing to oral levothyroxine to a maximum dose of 100 mcg (8 mcg/kg/day) daily. She did not require pericardiocentesis and was discharged well. Three months later, her thyroid function test showed normalization of TSH and FT4. Repeated echocardiogram showed smaller pericardial effusion. CONCLUSIONThis case report highlights a rare presentation of significant pericardial effusion secondary to severe primary hypothyroidism in a young female with Down’s syndrome. Furthermore, it emphasizes the need for vigilant monitoring of thyroid function in this population and timely intervention to prevent potentially serious complications.

Abordaje integral de la pericarditis aguda: un enfoque clínico actualizado

2025-05-30

José Rozado , Luis Gutiérrez de la Varga , Marı́a Martı́n | Medicina Clínica

Rehabilitation nursing of a patient with massive pericardial effusion caused by hypothyroid cardiopathy

2025-05-28

Yuyuan Mu | Chinese Journal of Integrative Nursing

Role of strain imaging by echocardiography in pericardial diseases; a scoping review

2025-05-27

Mohaddeseh Behjati , Pejman Mansouri , Shayan Mirshafiee +1 more

Human intravenous immunoglobulins: a promising treatment for recurrent pericarditis

2025-05-26

Emilia Lazarou , Charalambos Vlachopoulos , Konstantinos Tsioufis

The Value of Thin Layer Cytology in Cancer Patients’ Pericardial Effusions

2025-05-26

Christos Lafaras , Evdokia Mandala , Kyranna Lafara +6 more

Objective: Early diagnosis and treatment of metastatic pericardial disease are crucial to prevent the life-threatening complication of cardiac tamponade. Thin Layer Cytology (TLC), a widely adopted technique in cytology, has … Objective: Early diagnosis and treatment of metastatic pericardial disease are crucial to prevent the life-threatening complication of cardiac tamponade. Thin Layer Cytology (TLC), a widely adopted technique in cytology, has gained significant acceptance for most specimens. Our study aimed to assess the utility of TLC in diagnosing metastatic neoplasms and their origins in pericardial effusions, as well as monitoring response to chemotherapy. Methods: We examined 184 pericardial fluids collected by pericardiocentesis and processed using the ThinPrep liquid-based technique. Various immunocytochemical markers were used to determine the site of metastatic neoplasms. We also evaluated the response to therapy in 53 patients with lung and breast cancer. Results: Out of 184 specimens, 113 pericardial fluids were diagnosed as positive for malignancy, while 71 were negative. Twenty-three cases of unknown primary site were included in the total positive cases. Ninety cases positive for malignancy had a known primary site of origin, including 31 lung carcinomas, 22 breast carcinomas, 10 ovarian carcinomas, 6 T-cell lymphomas, 3 urinary bladder carcinomas, 4 renal carcinomas, 5 adenocarcinomas of the colon, 5 prostate carcinomas, 2 parotid adenocarcinomas, and 2 melanomas. Regarding the 53 cases with chemotherapy treatment, the cytologic examination of pericardial fluid showed a remarkable reduction in neoplastic burden after the third dose of cisplatin or thiotepa instilled into the pericardial cavity. ThinPrep provided excellent preservation of cytomorphological features, high cellularity per slide, and a clear background. This comprehensive analysis provides crucial information about the types and distribution of cancerous cells present in the samples. Conclusions: Thin Layer Cytology (TLC) is a valuable diagnostic tool for detecting metastatic pericardial malignancy. It allows the examination of exfoliated cells from the pericardial fluid, providing crucial information for diagnosis, management, and monitoring the acute responsiveness to intrapericardial chemotherapy. Immunocytochemistry (IHC) can identify specific markers for various types of cancer, enabling a more accurate diagnosis and guiding further treatment decisions.

Man With Chest Pain and Unilateral Weakness

2025-05-25

Holly Ryan , Molly Hartrich , Wesley Eilbert

A patient with dextrocardia at the outpatient stage: The complexity of diagnosis

2025-05-24

С. А. Кулакова , Svetlana Lagutina , Olga S. Skuratova +1 more

Understanding the specific features of this condition – dextrocardia (a congenital heart anomaly) – is important for physicians of various specialties, as it may affect patient management tactics and the … Understanding the specific features of this condition – dextrocardia (a congenital heart anomaly) – is important for physicians of various specialties, as it may affect patient management tactics and the choice of treatment methods. The presented clinical observation presents the features of observation and diagnosis of a patient with a developmental anomaly. The patient of 22 years old came to the local outpatient clinic for dynamic observation. Anamnesis: the patient has no hereditary predisposition to cardiovascular diseases. The following examination methods were performed: electrocardiography (ECG), echocardiography (EchoCG) and laboratory tests. The results showed that the patient has signs of acute coronary syndrome. This conclusion was made incorrectly, since the patient’s specific feature was not taken into account when applying the electrodes. When taking an ECG from a patient with dextroversion, the electrodes are applied as if the heart is left-sided, which leads to questionable and unreliable research results. Thus, judging by the latest examination results, the ECG suggests the presence of a possible previous inferior MI of indefinite duration, while the ECHO-CG confirms the absence of zones of impaired local contractility and the presence of satisfactory general contractility. It can be concluded that with a right-formed, right-located heart, it is inappropriate to apply electrodes during ECG recording, as with a left-sided position of the heart. With dextroversion, the electrocardiogram (ECG) may be uninformative due to the atypical location of the heart. In this case, additional examination methods are used for accurate diagnosis and assessment of the patient’s condition – ultrasound – EchoCG, computed tomography.

Unexpected Development of Pericardial Effusion in a Patient With Influenza and Secondary Bacterial Infection

2025-05-24

Pooriya Bahadoran , Daniel Echeverria , Hansani Angammana +2 more

Influenza poses a significant burden on healthcare systems worldwide, particularly when complicated by bacterial coinfections. Such cases often require intensive medical management. We present the case of a previously healthy … Influenza poses a significant burden on healthcare systems worldwide, particularly when complicated by bacterial coinfections. Such cases often require intensive medical management. We present the case of a previously healthy young man whose influenza infection was complicated by bacterial coinfection, necessitating complex therapeutic intervention. During treatment with intrapleural fibrinolytic therapy, the patient was found to have developed a large pericardial effusion. While a causal relationship cannot be definitively established, this temporal association raises concern for a potential, previously unreported complication. We present this case to raise clinical awareness of this life-threatening possibility and encourage its consideration in the differential diagnosis when managing similar patients.