Pericardial Disease

2014 ◽  
pp. 843-850
Author(s):  
Leonard S. Lilly
Keyword(s):  
Cardiac Tamponade ◽  
Constrictive Pericarditis ◽  
External Surface ◽  
Pericardial Fluid ◽  
Great Vessel ◽  
Acute Pericarditis ◽  
Inner Membrane ◽  
Pericardial Disease ◽  
Parietal Pericardium

The pericardium is a two-layered sac that surrounds the heart. It is composed of an outer stiff fibrous coat (the parietal pericardium) and a thin inner membrane that is adherent to the external surface of the heart (the visceral pericardium). The visceral pericardium reflects back at the level of the great vessel origins to form the inner lining of the parietal layer. The space between these two layers normally contains 15–50 mL of serous pericardial fluid, which permits the heart to contract in a minimum-friction environment. The major diseases of the pericardium are acute pericarditis, cardiac tamponade, and constrictive pericarditis.

Pericardial Diseases

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

Diseases of the Pericardium, Cardiac Tumors, and Cardiac Trauma

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.

The pericardium and pericardial disease

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.

scholarly journals 1095 Effective image-guided medical management in effusive constrictive pericarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Montes ◽  
A Cecconi ◽  
T Alvarado ◽  
A Vera ◽  
A Barrios ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Medical Treatment ◽  
Constrictive Pericarditis ◽  
Pericardial Fluid ◽  
Pericardial Window ◽  
Acute Pericarditis ◽  
Intravenous Corticosteroid ◽  
Persistent Inflammation ◽  
High Doses ◽  
Effusive Constrictive Pericarditis

Abstract A 59 year old man was admited to hospitalization for persistent chest pain related to acute pericarditis. Within the admision tests, a transthoracic echography was performed, showing a moderate pericardial effusion with ventricular septal bounce and significant respiratory variations in mitral and tricuspid inflows, all of it consistent with effusive-constrictive pericarditis (Panel A). Anti-inflammatory treatment with ibuprofen and colchicine was started. During the first 48 hours of admission there was a clinical and hemodinamic worsening in the patient’s condition that forced the performance of a pericardial window, obtaining a very little quantity of dense pericardial fluid. Looking for a more accurate study of the pericardium, a cardiovascular magnetic resonance (CMR) was performed, revealing a thick heterogeneous pericardial effusion (Panel B) and a significant late gadolinium enhancement of both pericardial layers (Panel C). All these findings where consistent with an effusive constrictive pericarditis with persistent inflammatory activity despite high doses of conventional inflammatory treatment. Furthermore, the growth of Propionibacterium acnes in the pericardial fluid disclosed the etiology of this condition. Medical treatment was enhanced with high doses of intravenous corticosteroid, ceftriaxone and doxycycline. During the following days, the patient showed an excellent response achieving the complete clinical and echocardiographic relief of constrictive signs (Panel D). Effusive constrictive pericarditis is characterized by the presence of pericardial effusion and constriction secondary to an inflammatory process of the pericardium. Pericardiectomy might be necessary in case of failure of medical treatment, a very common scenario in this kind of .pericarditis. Our case is remarkable because it demonstrates the value of CMR to detect persistent inflammation of pericardium despite high doses of conventional medical treatment for pericaricarditis guiding the successful escalation to intravenous corticosteroid and avoiding the risk of an unnecessary cardiac surgery. Abstract 1095 Figure.

Pericardial diseases

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 ...

Effusive–constrictive pericarditis in the spectrum of pericardial compressive syndromes

Heart ◽  
2021 ◽  
Vol 107 (6) ◽  
pp. 450-455
Author(s):  
Scott E Janus ◽  
Brian D Hoit
Keyword(s):  
Constrictive Pericarditis ◽  
Clinical Evidence ◽  
Pericardial Fluid ◽  
Right Atrial ◽  
Pericardial Disease ◽  
Non Invasive ◽  
Prevalence Estimates ◽  
Diagnostic Modalities ◽  
The Right ◽  
Effusive Constrictive Pericarditis

When pericardial fluid accumulates and exceed the reserve volume of the pericardium or when the pericardium becomes scarred and inelastic, one of three pericardial compressive syndromes may ensue, namely, cardiac tamponade (CT), characterised by the accumulation of pericardial fluid under pressure; constrictive pericarditis (CP), the result of scarring and loss of the normal elasticity of the pericardial sac; and effusive–constrictive pericarditis (ECP), characterised by the concurrence of a tense pericardial effusion and constriction of the heart by the visceral pericardium. Although relatively uncommon, prevalence estimates vary widely and depend on the nature of the cohorts studied, the methods used to diagnose ECP and the manner in which ECP is defined. Most cases of ECP are idiopathic, reflecting the frequency of idiopathic pericardial disease in general, and other causes include radiation, malignancy, chemotherapy, infection and postsurgical/iatrogenic pericardial disease. The diagnosis of ECP often becomes apparent when pericardiocentesis fails to decrease the right atrial pressure by 50% or to a level below 10 mm Hg. Important non-invasive diagnostic modalities include echocardiography, cardiac magnetic resonance and, to a lesser extent, cardiac CT. In cases with clear evidence of pericardial inflammation, a trial of an anti-inflammatory regimen is warranted. A complete pericardiectomy should be reserved for refractory symptoms or clinical evidence of chronic CP.

An Unusual Presentation of Tuberculous Pericardial Effusion

2009 ◽  
Vol 1 (3) ◽  
pp. 71-72
Author(s):  
Shaheen LNU ◽  
Rajyashri Sharma ◽  
Parvez Anjum ◽  
Pathak Jayshree
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Pericardial Fluid ◽  
Accurate Diagnosis ◽  
Unusual Presentation ◽  
Severe Bleeding ◽  
Acute Pericarditis ◽  
Prompt Treatment ◽  
Antitubercular Treatment ◽  
Life Saving

ABSTRACT Tuberculosis accounts for upto 4% of acute pericarditis and 7% cases of cardiac tamponade. 19% of women with tuberculosis can present with menorrhagia. Prompt treatment can be life saving but requires accurate diagnosis. We report a case of 25-year-old women who presented with severe bleeding per vaginum for four days. She was in shock. Echocardiography showed moderate pericardial effusion with features of cardiac tamponade. ADA was positive in aspirated pericardial fluid. The patient responded well to antitubercular treatment.

scholarly journals Cardiac manifestations of tuberculosis in a tertiary care center of Nepal

2018 ◽  
Vol 15 (1) ◽  
pp. 35-38
Author(s):  
Smriti Shakya ◽  
Sunil Chandra Jha
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Care Center ◽  
Tertiary Care ◽  
Pericardial Fluid ◽  
Age Group ◽  
Acute Pericarditis ◽  
Old Patients ◽  
Large Pericardial Effusion ◽  
2D Echocardiography

Background and Aims: Tuberculosis remains an important etiological cause of pericarditis and pericardial effusion in developing countries like Nepal. The objective of this study is to identify the various presentations of tuberculous pericarditis along with the demographic profile in our context and their short term outcome.Methods: We studied 53 patients from September 2015 to August 2017 regardless of age and gender who presented to Manmohan Cardiothoracic Vascular and Transplant Center with pericarditis of tubercular origin. The various manifestations of the disease were categorized with 2D echocardiography. Pericardiocentesis was done in patients with large pericardial effusion especially in cardiac tamponade and pericardiectomy done in chronic constrictive pericarditis(CCP). Antitubercular therapy with steroids was instituted.Results: Out of 53 patients, 62% were male and 38% were female. The ages ranged from 6-71 years (42±19.5). Twenty three percent of patients were from the age group 61-70yrs, 20% seen in age group 21-30 years, 8% in less than 10 yrs and 2% in above 70yrs old patients. The most common manifestation seen was large pericardial effusion (32%), followed by CCP (22.6%), 19% presented in cardiac tamponade, 2% had pyopericardium, 2% had perimyocarditis and 4% had acute pericarditis. Adenosine deaminase (ADA) was positive in 75% of the cases when pericardial fluid was tapped. Two patients developed CCP during follow up. Two patients succumbed to death during hospital stay.Conclusion: A high index of suspicion of tubercular pericarditis is inevitable in our settings where other sophisticated investigations are still lacking.Nepalese Heart Journal 2018; 15(1) 35-38

scholarly journals A case of tuberculosis pericarditis with an interesting echocardiographic image

2018 ◽  
Author(s):  
Kursat Arslan ◽  
Ufuk Taner ◽  
Suleyman Cagan Efe ◽  
Burak Ayca ◽  
Turgut Karabag
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Constrictive Pericarditis ◽  
Extrapulmonary Tuberculosis ◽  
Pericardial Fluid ◽  
Fluid Accumulation ◽  
Echocardiographic Image ◽  
Rare Manifestation ◽  
Echocardiographic Images

Tuberculosis-associated pericardial disorders are an excessively rare manifestation of extrapulmonary tuberculosis. The patients may present with constrictive pericarditis or pericardial fluid accumulation leading to cardiac tamponade. This paper reports a case of tuberculosis-associated pericardial effusion with dense fibrinous material not causing tamponade in a foreigner presenting with nonspecific symptoms. It also provides a discussion about the diagnostic and therapeutic methods as well as interesting echocardiographic images of the patient.

Hemophilus Influenzae b Pericarditis in Children

PEDIATRICS ◽  
1975 ◽  
Vol 56 (5) ◽  
pp. 808-818
Author(s):  
Peter Echeverria ◽  
Edward W. P. Smith ◽  
David Ingram ◽  
Robert M. Sade ◽  
Pierce Gardner
Keyword(s):  
Cardiac Tamponade ◽  
Constrictive Pericarditis ◽  
Pericardial Fluid ◽  
Recent Experience ◽  
Surgical Drainage ◽  
Diagnosis And Management ◽  
Hemophilus Influenzae ◽  
Infectious Focus

Recent experience in the diagnosis and management of Hemophilus influenzae b pericarditis is described in five children. Anterior pericardectomy appears to be the preferred method of surgical drainage because it was associated with a shorter hospitalization than pericardiocentesis or closed or open pericardotomy and removed the risk of recurrent cardiac tamponade and constrictive pericarditis. Countercurrent immunoelectrophoresis of sera and pericardial fluid was used to rapidly identify the etiology of pericarditis in four of four patients tested. The observation that three children appeared to develop pericarditis in the absence of a contiguous infectious focus suggests that bacteremic seeding of the pericardium may be important in the pathogenesis of this disease.

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