Pericardial diseases

Pericardial diseases have multiple clinical presentations with acute and chronic complications. Early diagnosis and prompt treatment markedly enhance the chance of complete resolution of the hemodynamic complications of pericardial disease. The treatment of patients with acute idiopathic pericarditis is mainly to alleviate symtoms of chest pain. A nonsteroidal anti-inflammatory agent such as indomethacin is our first drug of choice. Therapy is effective and symptoms resolve within 24 to 48 hours. In patients with chronic recurrent idiopathic pericarditis, we advise the use of colchicine at 1 mg/d. Constrictive pericarditis is a progressive disease and surgical pericardiectomy is the only definite treatment. It should be performed early in the disease process before myocardial fibrosis occurs. Cardiac tamponade is a cardiac emergency and patients should be treated promptly. We often start with volume expansion with intravenous fluid in preparation for transcutaneous pericardiocentesis. Echocardiographically guided, transcutaneous pericardiocentesis is the procedure of choice. Patients with asymptomatic pericardial effusion are followed with serial echocardiography, and reserve drainage for enlarging effusions if there are signs of cardiac compression.