Pericardial disease

Acute pericarditis typically is a self-limited disease, usually idiopathic or of viral origin, that responds to treatment with NSAIDs. The recent COPE Trial indicates a better outcome if all patients receive a 3-month course of colchicine. The use of steroids to treat acute pericarditis should be avoided because they increase the risk of recurrence. Cardiac tamponade is a life-threatening condition caused by a pressurized pericardial effusion. Doppler echocardiography plays a key role in its recognition, and echocardiogram-guided pericardiocentesis has become the treatment of choice in most instances. Pericardial constriction is a potentially treatable cause of chronic heart failure that must be distinguished from restrictive cardiomyopathy. This can be accomplished with a combination of Doppler echocardiography, Doppler tissue imaging, MRI, and cardiac catheterization. In effusive constrictive pericarditis, the cardiac compression is due to both a pressurized pericardial effusion and pericardial restriction. Pericardiocentesis converts the hemodynamics from tamponade to constriction. © 2006 American Heart Association, Inc.