Pericardial Disease

The pericardium is a thin fibrous sac that encircles and envelops the heart while providing it structural support. 

Acute pericarditis, pericardial tamponade, and pericardial constriction are some of the most significant pericardial diseases. 


Causes

Acute pericarditis

Cardiac tamponade

Pericardial constriction

  • Idiopathic (cause is unknown)
  • Infection
  • Myocardial infarction
  • Malignancy 
  • Renal failure
  • Trauma 
  • Post-cardiac injury syndrome
  • Radiation
  • Pericardial sac infection (viral or bacterial)
  • Cancer
  • Pericardial inflammation caused by a heart attack
  • Trauma
  • Autoimmune disease
  • Reactions to specific medications or treatments
  • Metabolic causes such as chronic kidney failure
  • Open heart surgery
  • Cardiac surgery
  • Mediastinal radiationtherapy
  • Idiopathic constriction 
  • Tuberculosis 
  • Pericarditis

Signs and symptoms 

Acute pericarditis

Cardiac tamponade

Pericardial constriction

  • Sharp pain in the chest, which may spread to the neck, arms, or left shoulder
  • Pericardial friction rub characterised by high-pitched, squeaky or scratchy sounds
  • Nausea
  • Shortness of breath
  • Anxiousness 
  • Chest pain
  • Shoulder discomfort
  • Abdominal discomfort
  • Nausea
  • Malaise
  • Fatigue
  • Exertional dyspnoea
  • Reduced tolerance for exercise 
  • Abdominal discomfort
  • Peripheral oedema
  • Ascites
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea

Diagnosis

Acute pericarditis

Cardiac tamponade

Pericardial constriction

  • Evaluation of medical history
  • Physical examination
  • Electrocardiography (ECG)
  • Echocardiogram
  • Magnetic resonance imaging (MRI) 
  • Computed tomography (CT)
  • Physical examination
  • Electrocardiography (ECG)
  • Echocardiogram 
  • Chest radiography
  • Electrocardiography (ECG)
  • Echocardiogram 
  • Brain natriuretic peptide (BNP) biomarker
  • Chest radiography

Treatment options

Acute pericarditis

Cardiac tamponade

Pericardial constriction

  • Medicines e.g., combination therapy using nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine
  • Prompt drainage of pericardial fluid through pericardiocentesis
  • Medicines e.g., anti-inflammatory agents and diuretics
  • Pericardiectomy (surgical excision of a portion or most of the pericardium)

Prevention

While pericardial diseases such as acute pericarditis and cardiac tamponade cannot be prevented, measures can be taken to reduce your risk of experiencing another acute episode or complication. These include:

  • Receiving immediate treatment 
  • Adhering to the treatment plan recommended by your doctor
  • Looking after your heart by exercising frequently, eating healthily and maintaining a healthy weight

Visit your nearest Gleneagles Hospital to learn more about our Cardiology Services



References:

  1. Pericardial disease. Circulation 2006;113(12):1622-32 [Accessed on 10 May 2022]
  2. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010;85(6):572-93 [Accessed on 10 May 2022]
  3. Pericardial disease. Available at https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/pericardial-disease/ [Accessed on 10 May 2022]
  4. Cardiac tamponade. Available at https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cardiac-tamponade.html [Accessed on 10 May 2022]
  5. Prevention and treatment of pericarditis. Available at https://www.heart.org/en/health-topics/pericarditis/prevention-and-treatment-of-pericarditis#: [Accessed on 10 May 2022]