Overview of pericardial syndromes

ESC CardioMed ◽

10.1093/med/9780198784906.003.0375 ◽

2018 ◽

pp. 1561-1563

Author(s):

Michael Arad ◽

Yehuda Adler

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Pericardial Effusion ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Pericardial Diseases ◽

Pericardial Syndromes ◽

Work Up ◽

Systemic Condition ◽

Symptoms And Signs

Pericardial diseases manifest as a part of a systemic condition or in isolation. The clinical presentation is driven by inflammation (i.e. pericarditis), excess fluid accumulation (pericardial effusion), or pericardial stiffening (constriction). Corresponding symptoms and signs may include pain, stigmata of systemic inflammation, atrial arrhythmia, haemodynamic compromise, or chronic heart failure. Pericardial tumours and space-occupying lesions are uncommon and may be incidentally detected or present as one of the above-mentioned forms of pericardial disease. Aetiological work-up is usually unnecessary in acute pericarditis but is indicated in the incessant/chronic form and to exclude bacterial infection. Pericardial effusions need to be investigated when large and promptly evacuated when associated with haemodynamic compromise. The hallmark of constrictive physiology is ventricular interdependence. It is important to distinguish transient constriction and to treat inflammation according to aetiology prior to making a decision on surgical relief by pericardiectomy.

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Pericardial diseases

10.1093/med/9780199643219.003.0009 ◽

2012 ◽

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Tuberculous Pericarditis ◽

Pericardial Diseases ◽

Effusive Constrictive Pericarditis

Aetiology 460Syndromes of pericardial disease 461Acute pericarditis without effusion 461Pericardial effusion with or without tamponade 462Constrictive pericarditis 464Effusive-constrictive pericarditis 465Calcific pericarditis without constriction 465Viral pericarditis 466Tuberculous pericarditis 468Uraemic pericarditis 469Neoplastic pericardial disease 470Myxoedematous effusion ...

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Pericardial Diseases

10.2310/em.4025 ◽

2018 ◽

Author(s):

David W. Schoenfeld

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Constrictive Pericarditis ◽

Incidental Finding ◽

Systemic Disease ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Pericardial Cavity ◽

Pericardial Diseases ◽

Wide Range

Diseases of the pericardium represent a wide range of clinical syndromes that vary substantially in severity, from a benign pericardial effusion to fatal constrictive pericarditis or hemopericardium. Acute pericarditis is the most common pericardial disease, with viral and idiopathic as the most frequent etiologies. Typically, acute pericarditis can be managed as an outpatient with dual-agent therapy consisting of aspirin or nonsteroidal anti-inflammatory drug plus colchicine and rarely requires admission. Pericardial effusions are fluid collections in the pericardial cavity. They are a common incidental finding, can be associated with other systemic disease, and at their extreme, cause life-threatening cardiac tamponade. Cardiac tamponade exists on a spectrum with patients who are quasi stable to those where cardiovascular collapse and death are imminent. Cardiac tamponade may be temporized with fluid boluses, but treatment is through pericardiocentesis and occasional surgical intervention. Constrictive pericarditis is progressive process with poor prognosis in which the pericardium becomes rigid and causes diastolic dysfunction, leading to heart failure. Once the diagnosis is made, definitive management is surgical but carries a high operative risk. This review contains 7 highly rendered figures, 5 videos, 3 tables, and 42 references. Key Words: cardiac tamponade, constrictive pericarditis, effusive-constrictive pericarditis, pericardial effusion, pericarditis, pericardiocentesis

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e0602 The prognosis investigation in patients with chronic heart failure and pericardial effusion

Heart ◽

10.1136/hrt.2010.208967.602 ◽

2010 ◽

Vol 96 (Suppl 3) ◽

pp. A186-A186

Author(s):

Y. Shengbo ◽

Z. Qingyan ◽

H. He ◽

C. Donge ◽

C. Hongying ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Pericardial Effusion

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Diseases of the Pericardium, Cardiac Tumors, and Cardiac Trauma

10.2310/7900.1025 ◽

2016 ◽

Author(s):

Terrence D. Welch ◽

Kyle W Klarich ◽

Jae K. Oh

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy ◽

Left Ventricular ◽

Cardiac Tumors ◽

Management Options ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Cardiac Trauma ◽

Pulsed Wave Doppler

The pericardium consists of a fibrous sac and a serous membrane. Because of its simple structure, the clinical syndromes involving the pericardium are relatively few but vary substantially in severity. Cardiac tumors may be either primary or secondary and either benign or malignant, with attachment sites throughout the endocardium. Cardiovascular trauma should be suspected in all patients with chest injuries or severe generalized trauma. Cardiovascular injury may be either blunt or penetrating. This review covers pericardial disease, cardiac tumors, and cardiovascular trauma. Figures show an electrocardiogram in acute pericarditis; acute pericarditis with delayed gadolinium enhancement of the pericardium shown with cardiac magnetic resonance imaging; underlying cause of pericardial effusion requiring pericardiocentesis; pericardial pressure-volume curves; large pericardial effusion with swinging motion of the heart resulting in electrical alternans; typical pulsed-wave Doppler pattern of tamponade; underlying causes of constrictive pericarditis in patients undergoing pericardiectomy; pericardial calcification seen on a chest radiograph; thickened pericardium; typical pulsed-wave Doppler pattern of constrictive pericarditis; typical mitral annular tissue velocities in constrictive pericarditis; a diagnostic algorithm for the echocardiographic diagnosis of constrictive pericarditis; simultaneous right ventricular and left ventricular pressure tracings in restrictive cardiomyopathy; computed tomographic scan showing inflammatory constrictive pericarditis; systolic and diastolic transesophageal echocardiographic images of a large left atrial myxoma attached to the atrial septum; a decision tree of management options for patients with suspected papillary; transesophageal echocardiographic examples of aortic valve, mitral valve, left ventricular outflow tract, and tricuspid valve papillary fibroelastomas; and transesophageal short-axis view of the descending thoracic aorta in a hypotensive patient after a motor vehicle accident. The table lists tamponade versus constriction versus restrictive cardiomyopathy. This review contains 18 highly rendered figures, 1 table, and 77 references.

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The pericardium and pericardial disease

Practical Perioperative Transoesophageal Echocardiography ◽

10.1093/med/9780198759089.003.0016 ◽

2018 ◽

Author(s):

David Sidebotham ◽

Alan Merry ◽

Malcolm Legget ◽

Gavin Wright

Keyword(s):

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy ◽

Transoesophageal Echocardiography ◽

Pericardial Tamponade ◽

Acute Pericarditis ◽

Pericardial Disease ◽

Mechanically Ventilated ◽

Spectral Doppler ◽

Echocardiographic Assessment

Chapter 16 is a new chapter from earlier editions of Practical Perioperative Transoesophageal Echocardiography. It provides a short summary on the echocardiographic assessment of the normal pericardium and on pericardial disease. The characteristic TOE features of pericardial pathology (cysts, acute pericarditis, pericardial effusion, pericardial tamponade, and constrictive pericarditis) are reviewed. In particular, pericardial constriction is discussed in detail, including outlining the features that distinguish pericardial constriction from restrictive cardiomyopathy. Wherever possible, the spectral Doppler abnormalities associated with pericardial constriction and pericardial tamponade are discussed with reference to patients who are mechanically ventilated.

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Pericardial diseases in patients with hypothyroidism

Heart ◽

10.1136/heartjnl-2018-314528 ◽

2019 ◽

Vol 105 (13) ◽

pp. 1027-1033 ◽

Cited By ~ 6

Author(s):

Johnny Chahine ◽

Chandra K Ala ◽

James L Gentry ◽

Kevin M Pantalone ◽

Allan L Klein

Keyword(s):

Pericardial Effusion ◽

Current Knowledge ◽

Clinical Manifestations ◽

Disease Process ◽

Lymphatic Drainage ◽

Thyroid Stimulating Hormone ◽

Management Options ◽

Systematic Screening ◽

Pericardial Disease ◽

Pericardial Diseases

Hypothyroidism is a well-known cause of pericardial effusion (with an incidence of 3%–37%) and can cause cardiac tamponade in severe cases. In this review, we present the current knowledge on the epidemiology of hypothyroid-induced pericardial diseases, the mechanism through which low thyroid hormone levels affect the pericardium, the associated clinical manifestations, diagnostic tests and management options. Hypothyroidism causes pericardial effusion through increased permeability of the epicardial vessels and decreased lymphatic drainage of albumin, resulting in accumulation of fluid in the pericardial space. Interestingly, autoimmunity does not seem to play a major role in the pathophysiology, and a majority of effusions are asymptomatic due to slow fluid accumulation. The diagnosis is generally made when the pericardial disease is associated with an elevated thyroid-stimulating hormone level, and other secondary causes are excluded. Management consists of thyroid replacement therapy, along with pericardial drainage in case of tamponade.In conclusion, hypothyroidism-induced pericardial diseases are underdiagnosed. Initiating treatment early in the disease process and preventing complications relies on early diagnosis through systematic screening per guidelines.

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Pericardial disease

10.1093/med/9780198726012.003.0049 ◽

2016 ◽

Author(s):

Bernard Paelinck ◽

Aleksandar Lazarević ◽

Pedro Gutierrez Fajardo

Keyword(s):

Differential Diagnosis ◽

Pleural Effusion ◽

Pericardial Effusion ◽

Constrictive Pericarditis ◽

Restrictive Cardiomyopathy ◽

Tissue Doppler ◽

Doppler Imaging ◽

Two Dimensional ◽

Pericardial Disease ◽

Pericardial Diseases

Echocardiography is the cornerstone for the diagnosis of pericardial disease. It is a portable technique allowing morphological and functional multimodality (M-mode, two-dimensional, Doppler, and tissue Doppler) imaging of pericardial disease. In addition, echocardiography is essential for differential diagnosis (pericardial effusion vs pleural effusion, constrictive pericarditis vs restrictive cardiomyopathy) and allows bedside guiding of pericardiocentesis. This chapter describes normal pericardial anatomy and reviews echocardiographic features of different pericardial diseases and their pathophysiology, including pericarditis, pericardial effusion, constrictive pericarditis, pericardial cyst, and congenital absence of pericardium.

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Effects of a mindfulness-based intervention on symptoms and signs in chronic heart failure: A feasibility study

European Journal of Cardiovascular Nursing ◽

10.1177/1474515117715843 ◽

2017 ◽

Vol 17 (1) ◽

pp. 54-65 ◽

Cited By ~ 8

Author(s):

Jonna Norman ◽

Michael Fu ◽

Inger Ekman ◽

Lena Björck ◽

Kristin Falk

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Usual Care ◽

Feasibility Study ◽

Nyha Class ◽

Symptom Burden ◽

Heart Association ◽

Walking Distance ◽

Nyha Classification ◽

Symptoms And Signs

Aims: Despite treatment recommended by guidelines, many patients with chronic heart failure remain symptomatic. Evidence is accumulating that mindfulness-based interventions (MBIs) have beneficial psychological and physiological effects. The aim of this study was to explore the feasibility of MBI on symptoms and signs in patients with chronic heart failure in outpatient clinical settings. Methods: A prospective feasibility study. Fifty stable but symptomatic patients with chronic heart failure, despite optimized guideline-recommended treatment, were enrolled at baseline. In total, 40 participants (median age 76 years; New York Heart Association (NYHA) classification II−III) adhered to the study. Most patients ( n=17) were randomized into MBI, a structured eight-week mindfulness-based educational and training programme, or controls with usual care ( n=16). Primary outcome was self-reported fatigue on the Fatigue severity scale. Secondary outcomes were self-reported sleep quality, unsteadiness/dizziness, NYHA functional classification, walking distance in the six-minute walk test, and heart and respiratory rates. The Mann–Whitney U test was used to analyse median sum changes from baseline to follow-up (week 10±1). Results: Compared with usual care (zero change), MBI significantly reduced the self-reported impact of fatigue (effect size −8.0; p=0.0165), symptoms of unsteadiness/dizziness ( p=0.0390) and breathlessness/tiredness related to physical functioning (NYHA class) ( p=0.0087). No adverse effects were found. Conclusions: In stable but symptomatic outpatients with chronic heart failure, MBI alleviated self-reported symptoms in addition to conventional treatment. The sample size is small and further studies are needed, but findings support the role of MBI as a feasible complementary option, both clinically and as home-based treatment, which might contribute to reduction of the symptom burden in patients diagnosed with chronic heart failure.

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