Summary
Definition
History and exam
Key diagnostic factors
- malignancy
- presence of other risk factors
- dyspnoea
- raised jugular venous pressure (JVP)
- distant heart sounds
- pulsus paradoxus
- hypotension
- tachycardia
- recent cardiac surgery or intervention
- Beck's triad: hypotension, distant heart sounds, and raised JVP
Other diagnostic factors
- chest pain
- abdominal pain
- fever
- pericardial rub
Risk factors
- malignancy
- aortic dissection
- purulent pericarditis
- large idiopathic chronic pericardial effusion
- post-cardiac surgery or intervention
- tuberculosis (TB)
- autoimmune disease
- hypothyroidism
- end-stage renal failure
- anticoagulation
Diagnostic investigations
1st investigations to order
- ECG
- transthoracic echocardiogram
- CXR
- FBC
- erythrocyte sedimentation rate/CRP
- cardiac enzymes
Investigations to consider
- cardiac CT
- cardiac MRI
- cardiac catheterisation
- pericardiocentesis fluid for culture and cytology
Treatment algorithm
without haemopericardium, trauma, or purulent effusion
with haemopericardium, trauma, or purulent effusion
Contributors
Authors
Antonio Abbate, MD, PhD
Ruth C. Heede Professor of Cardiovascular Medicine
Division of Cardiovascular Medicine
Berne Cardiovascular Research Center
University of Virginia School of Medicine
Charlottesville
VA
Disclosures
AA has received consultant fees from Kiniksa Pharmaceuticals. He is an author of references cited in this topic.
Acknowledgements
Dr Antonio Abbate would like to gratefully acknowledge Dr Vaikom S. Mahadevan, Dr Harsh Agrawal, Dr Jonathan Bella, Dr Liran Blum, and Dr Michael Spinelli, previous contributors to this topic.
Disclosures
VSM declares that he is a proctor for Edwards Lifesciences for transcatheter valves and also a proctor for Abbott for closure devices. HA, JB, LB, and MS declare that they have no competing interests.
Peer reviewers
Ramon Castello, MD
Professor of Medicine
Director of Echocardiography
Mayo Clinic
Jacksonville
FL
Disclosures
RC declares that he has no competing interests.
Differentials
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Cardiogenic shock
More DifferentialsGuidelines
- 2015 ESC guidelines on the diagnosis and management of pericardial diseases
- Clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease
More GuidelinesPatient information
Heart attack: what is it?
What you can do to prevent another heart attack
More Patient informationLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer