Evaluation and management of acute pericarditisRalph Shabetai, MDMassimo Imazio, MD
UpToDate performs a continuous review of over 375 journals and other resources. Updates are added as important new information is published. The literature review for version 15.1 is current through December 2006; this topic was last changed on January 12, 2007. The next version of UpToDate (15.2) will be released in June 2007. INTRODUCTION
The pericardium is a fibroelastic sac made up of visceral and parietal layers separated by a (potential) space, the pericardial cavity. In healthy individuals, the pericardial cavity contains 15 to 50 mL of an ultrafiltrate of plasma.
Diseases of the pericardium present clinically in one of four ways:
- Acute fibrinous pericarditis
- Pericardial effusion without major hemodynamic compromise
- Cardiac tamponade
- Constrictive pericarditis
The evaluation and management of acute pericarditis will be reviewed here. Recurrent pericarditis, cardiac tamponade, constrictive pericarditis, and non-hemodynamically compromising pericardial effusion are discussed separately. (See "Recurrent acute pericarditis" and see "Cardiac tamponade" and see "Constrictive pericarditis" and see "Diagnosis and treatment of pericardial effusion").ETIOLOGY
The pericardium may be involved in a large number of systemic disorders or may be diseased as an isolated process (show table 1). (See "Etiology of pericardial disease" http://dreddyclinic.com/forum/viewtopic.php?f=101&t=2468
The yield of the standard diagnostic evaluation in patients with acute pericarditis http://dreddyclinic.com/forum/viewtopic.php?f=101&t=2470
is relatively low. This was illustrated in two series that included a total of 331 patients who underwent an extensive evaluation [1,2]. A specific diagnosis was established in only 54 patients (16 percent). The most common were neoplasia (20 patients), tuberculosis (13 patients), nontuberculous infection (7 patients), and rheumatic disease (7 patients).
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