Heart Failure Reviews

, Volume 18, Issue 3, pp 255–266 | Cite as

Pericardial syndromes: an update after the ESC guidelines 2004

  • Petar M. Seferović
  • Arsen D. Ristić
  • Ružica Maksimović
  • Dejan S. Simeunović
  • Ivan Milinković
  • Jelena P. Seferović Mitrović
  • Vladimir Kanjuh
  • Sabine Pankuweit
  • Bernhard Maisch
Article

Abstract

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

Keywords

Pericardial syndromes Acute pericarditis Pericardial effusion Cardiac tamponade Recurrent pericarditis Constrictive pericarditis 

Notes

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Petar M. Seferović
    • 1
  • Arsen D. Ristić
    • 1
  • Ružica Maksimović
    • 2
  • Dejan S. Simeunović
    • 1
  • Ivan Milinković
    • 1
  • Jelena P. Seferović Mitrović
    • 1
  • Vladimir Kanjuh
    • 1
  • Sabine Pankuweit
    • 3
  • Bernhard Maisch
    • 3
  1. 1.Department of CardiologyClinical Center of Serbia and Belgrade University School of MedicineBelgradeSerbia
  2. 2.Department of RadiologyClinical Center of Serbia and Belgrade University School of MedicineBelgradeSerbia
  3. 3.Department of Internal Medicine-Cardiology, Faculty of MedicinePhilipps UniversityMarburgGermany

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