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                                                          PERICARDIAL  DISEASES

                                                          Andrew Ying-Siu Lee, MD,PhD.

 

(1)      PERICARDITIS :-

       Etiology include: infection, myocardial infarction, collagen diseases (systemic lupus erythematosus,

rheumatoid arthritis), uremia, tumors, trauma, radiation, drugs, post pericardectomy in heart surgery, idiopathetic.

 

       Common symptoms include: chest pain (aggravated by lying supine, coughing, deep inspiration, swallowing,

and attenuated by sitting up and leaning forward), dyspnea, fever, weakness.  Diagnosis include: pericardial

friction rub, electrocardiogram, echocardiography.

 

       Pericarditis may lead to pericardial effusion, cardiac tamponade and constrictive pericarditis, as follows.

 

       Therapy include: bed rest, anti-inflammatory agents, steroids, colchicines.

 

(2)      PERICARDIAL EFFUSION :-

       Pericarditis usually elicits pericardial effusion.  Therefore, aside from symptoms of pericarditis, pericardial

effusion may have constant oppressive dull pressure in chest, dysphasia (due to esophageal compression), cough

(due to tracheal compression), hiccup (due to phrenic nerve compression), hoarseness (due to recurrent laryngeal

nerve compression).

 

       Treatment is similar to that of pericarditis.  If pericardial effusion becomes massive, pericardiocentensis may be needed.

 

(3)      CARDIAC TAMPONADE :-

       Cardiac tamponade occurs when pericardial effusion becomes massive or too fast, so as to compress the heart

leading to abnormal heart function.  Common causes include: pericardial hemorrhage (post catheterization or heart

surgery, trauma, myocardial infarction, aortic aneurym rupture, anticoagulants etc.), pericarditis (due to tumors,

tuberculosis, virus, uremia etc. ), and accumulation of lymphatic fluid due to malignant cancers.

 

       Symptoms usually due to low cardiac output and venous engorgement including: chest pain, dyspnea, weakness,

hypotensive, tachycardia, neck vein engorgement, small quite heart, abnormal pulses, restless, cold extremity, stupor,

heart failure etc.  Diagnosis include: electrocardiogram, echocardiography, cardiac catheterization.

 

       Cardiac tamponade requires urgent pericardiocentensis.  If pericardial effusion re-accumulates, pericardiotomy

or pericardectomy may be considered.

 

(4)      CONSTRICTIVE PERICARDITIS :-

       Constrictive pericarditis occurs when pericarditis elicits pericardial effusion with fibrin deposition leading to

thickened pericardium, thereby diastolic dysfunction and low cardiac output.  Etiology is similar to that of pericarditis,

although tumors, infection, radiation and trauma are more common.

 

       Symptoms include: weakness, edema, ascite, dyspnea, small heart sound, liver and spleen enlargement.  Diagnosis

include: electrocardiogram, chest X-ray, echocardiography, cardiac catheterization etc.

 

       Resection of pericardium is needed to cure constrictive pericarditis.