Pericardial disease

Overview

• The pericardium is a double-walled sac containing the heart and the roots of the great vessels.
• Pericardial disease encompasses various conditions affecting the pericardium including pericarditis, pericardial effusion, and constrictive pericarditis.

Acute Pericarditis

• Definition: Inflammation of the pericardium.
• Etiology: Viral (e.g., coxsackievirus), post-MI, post-cardiac surgery, autoimmune, tuberculosis, malignancy.
• Symptoms: Chest pain (sharp, pleuritic, improving with sitting up), fever.
• Signs: Pericardial friction rub.
• ECG: Widespread ST elevation and PR depression.
• Treatment: NSAIDs, colchicine, and treat underlying cause.

Pericardial Effusion

• Definition: Accumulation of fluid in the pericardial space.
• Etiology: Inflammation, infection, malignancy, trauma, renal failure, hypothyroidism.
• Symptoms: Asymptomatic to dyspnoea, chest pain, cough.
• Signs: Distant heart sounds, hypotension, tachycardia.
• Investigations: Echocardiogram (diagnostic of choice), ECG, CXR.
• Treatment: Pericardiocentesis if symptomatic or tamponade present.

Cardiac Tamponade

• Definition: Compression of the heart by an accumulation of fluid in the pericardial sac.
• Symptoms: Dyspnoea, chest pain, anxiety.
• Signs: Beck’s triad (hypotension, distended neck veins, muffled heart sounds), pulsus paradoxus.
• Investigations: Echocardiogram, ECG (low voltage QRS, electrical alternans).
• Treatment: Emergency pericardiocentesis, surgery.

Constrictive Pericarditis

• Definition: Chronic inflammation leading to a thickened, fibrotic, adherent pericardium restricting diastolic filling.
• Etiology: Tuberculosis (common worldwide), previous cardiac surgery or radiation, viral pericarditis, rheumatoid arthritis.
• Symptoms: Fatigue, dyspnoea, oedema.
• Signs: Raised JVP, Kussmaul’s sign, pericardial knock, hepatomegaly.
• Investigations: CT/MRI, echocardiogram, cardiac catheterization.
• Treatment: Diuretics for symptom relief, surgical pericardiectomy for definitive management.