Pericardial Disease

From WikiLectures

15e – Pericardial disease[edit | edit source]

Acute pericarditis:

  • Inflammation of pericardium which may be primary or secondary to systemic diseases
  • Causes :
  1. Viruses (coxsackie, flu, EBV, mumps, varicella, HIV)
  2. Bacteria (pneumonia, rheumatic fever, TB)
  3. Fungi
  4. Myocardial infarction
  5. Others: uremia, Rheumatoid arthritis, SLE, myxedema, trauma, surgery, malignancy, radiotherapy

Clinical feature:

  • Central chest pain worse on inspiration or lying flat – relieved by sitting forward
  • Pericardial friction rub may be heard
  • Look for evidence of pericardial effusion or cardiac temponade
  • Fever may occur


  • ECG – classically shows concave (saddle-shaped) ST segment elevation, non spec
  • Blood test – FBC, ESR, U&E, cardiac enzymes, viral serology, blood cultures, TFT
  • ECHO


  • Analgesia – ibuprofen
  • Treat the cause
  • Consider colchicine before steroids/immunosuppressant

Pericardial effusions:

  • Accumulation of fluid in the pericardial sac
  • Cause : any cause of pericarditis
  • Clinical pictures:
  • Dyspnea, raised JVP, bronchial breathing, look for sign of cardiac tamponade


  • CXR – enlarged, globular heart
  • ECG – low voltage QRS complexes and alternating QRS morphologies
  • ECHO – echo-free zone surrounding the heart


  • Treat the cause
  • Pericardiocentesis may be diagnostic or therapeutic
  • Send pericardial fluid for culture, ZN stain/TB culture, cytology

Constrictive pericarditis:

  • The heart is encase in rigid pericardium
  • Causes: often unknown – TB or after any pericarditis
  • Clinical pictures:
  1. Often RHF with increase JVP, Kaussmaul sign
  2. Soft, diffuse apex beat, quiet heart sound
  3. Diastolic pericardial knock
  4. Hepatosplenomegaly, ascites, edema


  • CXR – small heat +/- pericardial calcification
  • ECHO
  • Cardiac catheterization

Management : surgical excision

Cardiac tamponade:

  • Accumulation of pericardial fluid raises intra-pericardial pressure, hence poor ventricular filling and fall in cardiac output
  • Causes:
  1. Any pericarditis
  2. Aortic dissection
  3. Heamodialysis
  4. Warfarin
  5. Traseptal puncture at cardian catheterization
  6. Post cardiac biopsy


  • Pulse increase, bp decreases, pulsus paradoxus, JVP increases, kaussmaul’s sign,
  • Muffled S1&S2


  • Beck’s triad: falling bp, rising JVP, small, quiet heart
  • Big globular heart ( if > 250ml fluid)
  • ECG – low voltage QRS +/- electrical alternans
  • ECHO – diagnostic, echo-free zone around the heart, diastolic collapse of RA&RV

Management :

  • Seek expert help
  • Urgent drainage
  • Send fluid for culture, ZN stain/TB culture and cytology


  • OHCM – Cardiovascular medicine, page 140
  • OHCM – practical procedure, pericardiocentesis, page 761