SymPoSIum on CARDIovASCuLAR DISEASES
Pericardial Disease: Diagnosis and Management
Masud H. Khandaker, MD, PhD; Raul E. Espinosa, MD; Rick A. Nishimura, MD; Lawrence J.Sinak, MD; Sharonne N. Hayes, MD; Rowlens M. Melduni, MD; and Jae K. Oh, MD
On completion of this article, you should be able to: (1) identify the diagnostic criteria for acute and relapsingpericarditis, cardiac tamponade, and constrictive pericarditis; (2) integrate the information obtained from a history, physical examination, electrocardiography, and laboratory studies to determine if furtherimaging modalities or invasive cardiac catheterization is necessary for the diagnosis of the various pericardial syndromes; and (3) apply management strategies on the basis of evidence and clinicalexperience to decrease morbidity and improve survival in patients with pericardial disease.
Pericardial diseases can present clinically as acute pericarditis, pericardial effusion, cardiac tamponade, andconstrictive pericarditis. Patients can subsequently develop chronic or recurrent pericarditis. Structural abnormalities including congenitally absent pericardium and pericardial cysts are usuallyasymptomatic and are uncommon. Clinicians are often faced with several diagnostic and management questions relating to the various pericardial syndromes: What are the diagnostic criteria for the vastarray of pericardial diseases? Which diagnostic tools should be used? Who requires hospitalization and who can be treated as an outpatient? Which medical management strategies have the best evidencebase? When should corticosteroids be used? When should surgical pericardiectomy be considered? To identify relevant literature, we searched PubMed and MEDLINE using the keywords diagnosis, treatment,management, acute pericarditis, relapsing or recurrent pericarditis, pericardial effusion, cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy. Studies were selected on the...