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  • Review Article
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Diagnosis and management of pericardial diseases

Nature Reviews Cardiology volume 6, pages 743–751 (2009)Cite this article

Abstract

The management of pericardial diseases is largely empirical because of the relative lack of randomized trials that involve patients with these conditions. A first attempt to bring together and organize current knowledge resulted in the publication of the first guidelines on the management of pericardial diseases. Nevertheless, a number of observational studies and the first randomized trials are moving the management of pericardial diseases towards evidence-based medicine, particularly for pericarditis. Emerging data indicate that management can be tailored to the individual patient and, although the optimal duration of treatment is not clearly established, some recommendations can be formulated to guide management and follow-up.

Key Points

  • The clinical diagnosis of pericarditis is confirmed when at least two of four clinical criteria are present—typical chest pain, pericardial friction rub, widespread ST-segment elevation, and pericardial effusion

  • Tests for pericarditis include electrocardiography, echocardiography, chest radiography and measurement of markers of inflammation (C-reactive protein, erythrocyte sedimentation rate) and myocardial lesions (troponin); etiology searches and hospitalization are restricted to high-risk patients

  • High-risk features for pericarditis (predictive of nonviral, nonidiopathic etiologies and complications) include fever >38 °C, a subacute course, large pericardial effusion or cardiac tamponade, and failure of aspirin or NSAIDs

  • Pericardiocentesis is indicated for cardiac tamponade, high suspicion of tuberculous, purulent or neoplastic pericarditis and can also be considered for large or symptomatic effusions refractory to medical treatment

  • Pericardial biopsy is indicated in patients with persistent, worsening illness without a definite diagnosis despite medical therapy (diagnostic) and with relapsing tamponade or large effusions with severe symptoms (therapeutic)

  • Pericardiectomy is essentially recommended for persistent constriction; patients with newly diagnosed constriction who are hemodynamically stable can be given a trial of anti-inflammatory therapy for 2–3 months before pericardiectomy

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Figure 1: Triage of pericarditis according to the Torino experience.
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Acknowledgements

Désirée Lie, University of California, Orange, CA is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Cardiology Department, Maria Vittoria Hospital, Torino, Italy

    Massimo Imazio & Rita Trinchero

  2. Department of Internal Medicine, Ospedali Riuniti, Bergamo, Italy

    Antonio Brucato

  3. Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv and Misgav Ladach Hospital, Jerusalem, Kupat Holim Meuhedet, Israel

    Yehuda Adler

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Correspondence to Massimo Imazio.

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Imazio, M., Brucato, A., Trinchero, R. et al. Diagnosis and management of pericardial diseases. Nat Rev Cardiol 6, 743–751 (2009). https://doi.org/10.1038/nrcardio.2009.185

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