Summary
Definition
History and exam
Key diagnostic factors
- malignancy
- presence of other risk factors
- dyspnea
- elevated jugular venous pressure (JVP)
- distant heart sounds
- pulsus paradoxus
- hypotension
- tachycardia
- recent cardiac surgery or intervention
- Beck triad: hypotension, distant heart sounds, and elevated 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 tests
1st tests to order
- ECG
- transthoracic echocardiogram
- CXR
- CBC
- erythrocyte sedimentation rate/CRP
- cardiac enzymes
Tests to consider
- cardiac CT
- cardiac MRI
- cardiac catheterization
- pericardiocentesis fluid for culture and cytology
Treatment algorithm
without hemopericardium, trauma, or purulent effusion
with hemopericardium, 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
Declarações
RC declares that he has no competing interests.
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Referências
Principais artigos
Klein AL, Abbara S, Agler DA, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013 Sep;26(9):965-1012.Texto completo Resumo
Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015 Nov 7;36(42):2921-64.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Cardiogenic shock
Mais Diagnósticos diferenciaisDiretrizes
- 2015 ESC guidelines on the diagnosis and management of pericardial diseases
- American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease
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