Pericardial Disease
Pericardial disease ranges from inflammation and effusion to tamponade and chronic constriction; the clinical priority is to identify the dominant syndrome, assess haemodynamic danger and cause, and match anti-inflammatory, drainage or surgical treatment to that syndrome.
Definition
Pericardial disease is pathology of the two-layered sac around the heart, including pericarditis, pericardial effusion, cardiac tamponade, myopericardial overlap and constrictive pericarditis. The dominant problem may be inflammation, fluid pressure or chronic restriction, and more than one may coexist.
First principles
The pericardium can inflame, fill or stiffen
Inflammation of the pericardial layers produces pericarditis and positional pain. Fluid, blood, pus or gas in the pericardial space produces an effusion, which becomes tamponade when pressure impairs diastolic filling. Fibrosis or calcification produces constriction, a rigid shell that limits filling chronically. One patient can move from one syndrome to another, so the assessment must be dynamic.
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