Cardiovascular Disorders

Pericardial Diseases

Clinical overview and exam mastery guide for acute pericarditis, pericardial effusion, tamponade emergencies, and constrictive pericarditis.

Pericarditis Core
NSAID plus colchicine
ECG Clue
Diffuse ST elevation
Tamponade
Drainage emergency
Constrictive Disease
Pericardiectomy definitive

Pericardial Disease Spectrum

Pericarditis Inflammatory pain NSAID + colchicine Effusion Fluid accumulation Monitor vs drain Tamponade Shock physiology Urgent drainage Chronic fibrotic endpoint: constrictive pericarditis Impaired ventricular filling with right-sided failure pattern

Key decision point: inflammation management versus emergency decompression.

1. What Are Pericardial Diseases?

The pericardium is the fibrous sac around the heart. High-yield pericardial conditions include acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis.

Acute pericarditis Pericardial effusion Cardiac tamponade Constrictive pericarditis

2. Acute Pericarditis

Pathophysiology and Causes

  • Pericardial inflammation
  • Common causes: viral, post-MI (Dressler), uremia, autoimmune disease

Classic Presentation

  • Sharp pleuritic chest pain
  • Worse supine, better leaning forward
  • Pericardial friction rub
  • ECG: diffuse ST elevation with PR depression
Drug/Class MOA Major Side Effects Contraindications / Notes
NSAIDs (ibuprofen, aspirin) COX inhibition lowers prostaglandin synthesis and inflammation GI irritation, bleeding risk, renal dysfunction Active GI bleeding, severe renal impairment
Colchicine (add-on) Microtubule inhibition reduces neutrophil-driven inflammation Diarrhea, GI upset Severe renal/hepatic impairment; strong recurrence-prevention role
Corticosteroids (reserved) Broad anti-inflammatory gene regulation effects Hyperglycemia, fluid retention, immunosuppression Reserve for autoimmune causes or NSAID failure; early use can raise recurrence risk

3. Pericardial Effusion

Pericardial effusion is fluid accumulation in the pericardial space. Small stable effusions can be monitored, while large or symptomatic effusions may require drainage.

4. Cardiac Tamponade

Pathophysiology

  • Rapid pressure rise in the pericardial sac
  • Reduced ventricular filling
  • Drop in cardiac output and shock risk

Classic Findings

  • Beck triad: hypotension, JVD, muffled heart sounds
  • Pulsus paradoxus
Definitive management is emergency pericardiocentesis. Drugs do not reverse tamponade physiology.
IV fluids may be used as temporary hemodynamic support while preparing for drainage.

5. Constrictive Pericarditis

Chronic pericardial scarring restricts ventricular filling and often presents with right-sided heart failure features. Definitive treatment is surgical pericardiectomy.

Management Recap Drill

Pericarditis 1: start NSAID as first-line anti-inflammatory therapy.
Pericarditis 2: add colchicine to reduce recurrence.
Pericarditis 3: reserve steroids for selected cases.
Tamponade: perform urgent pericardial drainage.
Constrictive disease: plan definitive surgical management.

Visual Algorithm Placeholder

[Insert Pericarditis and Tamponade Emergency Flowchart Here During UI Integration]

Guideline References (Management)

ESC Guidelines for Pericardial Diseases

https://www.escardio.org/Guidelines

Guideline Focus

  • NSAID and colchicine strategy
  • Recurrence prevention
  • Tamponade emergency management

6. Common Exam Traps

Colchicine lowers recurrence risk in acute pericarditis.
Pericarditis ST elevation is typically diffuse, not localized to one territory.
Tamponade requires drainage, not drug-only therapy.
Early steroid use can increase recurrence risk.
Pain that improves leaning forward supports pericarditis pattern.

7. Quick Revision Summary

Must Remember

  • Pericarditis presents with inflammatory positional chest pain
  • Standard regimen is NSAID plus colchicine
  • Tamponade is a drainage emergency
  • Constrictive disease reflects chronic pericardial scarring

Practice Questions Placeholder

  • Topic: Pericardial Diseases
  • Subtopics: acute pericarditis, colchicine, tamponade, constrictive pericarditis