Pericardial Diseases: Acute Pericarditis, Pericardial Effusion, and Cardiac Tamponade

Abstract

The pericardium is a tough, elastic sac that encases the heart that serves as the site of various diseases that can lead to morbidity and hospitalization, in particular acute pericarditis, pericardial effusion, and cardiac tamponade. Acute pericarditis results from inflammation of the pericardial layers most commonly caused by infection, autoimmune conditions, post-cardiac injury, or myocardial infarction. Most cases are idiopathic, presumed to be due to viral causes, and respond well to treatment with nonsteroidal anti-inflammatories and colchicine. These medications should be continued until there is symptomatic improvement then tapered slowly to avoid recurrence. Newer biologic agents, including IL receptor antagonists, have shown benefit for treating recurrent pericarditis, although their use in acute pericarditis is still being explored. Pericardial effusion occurs when fluid, blood, or pus accumulates in the pericardial space. While slow accumulation of fluid allows the pericardium to stretch, rapid accumulation of fluid can lead to impaired cardiac filling and decreased cardiac output, a condition known as cardiac tamponade. While pericardial effusions can be managed on an outpatient imaging with serial imaging, patients with malignant effusion or cardiac tamponade should be referred for emergency pericardiocentesis and drain placement. Pericardial window or pericardiectomy may be necessary in the case of recurrent effusion or constrictive physiology.