Pericardial disease refers to any condition that affects the pericardium, which is the double-layered sac surrounding the heart. The pericardium serves several important functions, including protecting the heart, anchoring it to surrounding structures (such as the diaphragm and great vessels), and preventing over-expansion of the heart during diastole (the phase when the heart fills with blood). When the pericardium becomes inflamed or affected by other conditions, it can lead to various problems that interfere with the normal functioning of the heart.

Types of Pericardial Disease
Pericardial disease can encompass a range of conditions, including inflammation, fluid accumulation, and fibrosis. The most common types of pericardial disease are:
1. Pericarditis
Pericarditis is the inflammation of the pericardium. It is typically caused by infection, autoimmune disorders, or injury, though the exact cause is not always identified.
- Acute Pericarditis: This is the most common form of pericarditis and typically causes sharp chest pain that worsens with deep breathing or coughing. Other symptoms may include fever and difficulty breathing. It is most often caused by viral infections, but bacterial infections, autoimmune diseases (like lupus or rheumatoid arthritis), and post-heart attack (post-myocardial infarction) reactions can also cause it.
- Chronic or Recurrent Pericarditis: Chronic or recurrent pericarditis can develop when inflammation lasts for more than a few weeks or returns repeatedly over time. It may be more resistant to treatment and can cause long-term discomfort.
- Causes of Pericarditis:
- Viral infections: Common viruses include Coxsackievirus, echovirus, or the viruses that cause the flu or the common cold.
- Bacterial infections: Can occur, especially following surgery or due to infections like tuberculosis or bacterial pneumonia.
- Autoimmune diseases: Conditions like systemic lupus erythematosus (SLE) or rheumatoid arthritis can cause pericarditis.
- Post-cardiac injury: This includes pericarditis following a heart attack (post-myocardial infarction), heart surgery, or radiation therapy.
- Medications: Certain drugs (such as hydralazine or procainamide) may cause drug-induced pericarditis.
- Cancer: Some cancers, especially lung or breast cancer, can spread to the pericardium.
2. Pericardial Effusion
A pericardial effusion refers to the accumulation of excess fluid in the pericardial sac. Normally, the pericardial sac contains a small amount of fluid to allow smooth movement of the heart. When fluid accumulates, it can increase the pressure on the heart, impairing its ability to fill and pump blood effectively.
- Causes of Pericardial Effusion:
- Infections (viral, bacterial, or tuberculosis)
- Cancer (especially metastatic cancers, like lung or breast cancer)
- Kidney failure (uremic pericarditis due to the buildup of toxins)
- Autoimmune diseases (like lupus or rheumatoid arthritis)
- Trauma (such as after a heart attack, surgery, or injury)
- Radiation therapy
- Post-surgery (following heart surgery or cardiac procedures)
- Symptoms of Pericardial Effusion:
- Often asymptomatic in mild cases.
- Larger effusions can cause symptoms like shortness of breath, chest discomfort, cough, or difficulty swallowing. If the pressure becomes too high, it may lead to cardiac tamponade, a life-threatening condition where the heart is compressed, reducing its ability to pump blood effectively.
3. Cardiac Tamponade
Cardiac tamponade is a medical emergency that occurs when fluid accumulates rapidly or in large amounts in the pericardial sac, putting pressure on the heart and preventing it from filling properly. This impairs the heart’s ability to pump blood and can lead to shock or death if not treated quickly.
- Symptoms of Cardiac Tamponade:
- Beck’s triad: A classic sign of tamponade, consisting of:
- Hypotension (low blood pressure)
- Jugular venous distension (enlarged neck veins)
- Muffled heart sounds (due to fluid around the heart)
- Shortness of breath
- Rapid heart rate (tachycardia)
- Pulsus paradoxus: A drop in blood pressure during inhalation that is greater than normal.
- Swelling of the abdomen or legs due to poor circulation.
- Beck’s triad: A classic sign of tamponade, consisting of:
- Treatment: Cardiac tamponade requires urgent intervention, often with a procedure called pericardiocentesis (removal of excess fluid via a needle) or surgery to drain the fluid and relieve the pressure on the heart.
4. Constrictive Pericarditis
Constrictive pericarditis is a rare, chronic condition where the pericardium becomes thickened and stiffened (fibrotic), often as a result of chronic inflammation or scarring. This rigidity prevents the heart from expanding and contracting properly during the cardiac cycle, impairing normal heart function.
- Causes of Constrictive Pericarditis:
- Chronic pericarditis (following multiple episodes of inflammation)
- Tuberculosis (in regions where TB is endemic)
- Radiation therapy (especially when used to treat cancers near the heart)
- Cardiac surgery or trauma that affects the pericardium.
- Symptoms:
- Shortness of breath
- Fatigue
- Swelling in the abdomen, legs, or feet (due to poor heart function)
- Palpitations
- Elevated jugular venous pressure
- Diagnosis and Treatment: Diagnosis typically involves imaging studies like CT scans, MRI, or an echocardiogram to assess the pericardium and the heart’s function. In some cases, a pericardial biopsy may be necessary. Treatment usually involves medications to control symptoms, but surgery (pericardiectomy) to remove the thickened pericardium may be required in severe cases.
Symptoms of Pericardial Disease
The symptoms of pericardial disease can vary widely depending on the type of condition, its severity, and whether it is acute or chronic. Common symptoms include:
- Chest pain: Often sharp or pleuritic in nature, worsening with deep breaths or coughing (seen in pericarditis).
- Shortness of breath: Due to impaired heart function or fluid accumulation.
- Fatigue: Caused by decreased heart efficiency.
- Swelling in the legs or abdomen: Due to poor blood flow or fluid retention.
- Palpitations: A sensation of irregular heartbeats, especially in cases of constrictive pericarditis or effusion.
- Cough or difficulty swallowing: Resulting from the pressure of fluid buildup or pericardial constriction on nearby structures.
Diagnosis of Pericardial Disease
Several diagnostic tools are used to identify pericardial diseases:
- Echocardiogram: A key imaging technique that can assess the thickness of the pericardium, detect fluid accumulation, and evaluate heart function.
- Electrocardiogram (ECG): Pericarditis may cause characteristic changes in the ECG, such as ST-segment elevation.
- Chest X-ray: Used to assess the size and shape of the heart and identify signs of fluid accumulation in the pericardium.
- CT scan or MRI: These advanced imaging techniques can provide detailed images of the pericardium and help diagnose constrictive pericarditis or large pericardial effusions.
- Pericardiocentesis: If fluid accumulation is suspected (pericardial effusion), a sample of the fluid may be withdrawn to analyze the cause (infection, cancer, etc.).
- Blood tests: Elevated inflammatory markers (like C-reactive protein or ESR) can suggest pericarditis or other inflammatory conditions.
Treatment of Pericardial Disease
The treatment of pericardial disease depends on the specific condition, its severity, and underlying causes.
1. Pericarditis
- Anti-inflammatory drugs: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to reduce inflammation and relieve pain. Colchicine may also be prescribed to prevent recurrence.
- Steroids: In more severe or chronic cases, corticosteroids like prednisone may be used to control inflammation.
- Antibiotics: If a bacterial infection is the cause of pericarditis, antibiotics are required.
- Treatment of underlying conditions: For autoimmune diseases or cancer, treating the underlying disease is crucial.
2. Pericardial Effusion and Cardiac Tamponade
- Pericardiocentesis: Fluid is drained from the pericardial sac using a needle and catheter.
- Surgical drainage: If pericardiocentesis is not effective or if the effusion recurs, surgery may be required to drain the fluid permanently.
- Treating the underlying cause: Whether it’s an infection, cancer, or autoimmune disease, the cause of the effusion must be addressed.
3. Constrictive Pericarditis
- Medical management: Diuretics and anti-inflammatory medications may help control symptoms, but they are not a cure.
- Pericardiectomy: The surgical removal of the thickened pericardium is often the treatment of choice for severe cases of constrictive pericarditis.
Prognosis
The prognosis of pericardial disease depends on the specific condition and the effectiveness of treatment. In many cases, conditions like acute pericarditis or pericardial effusion can be treated successfully with medications or drainage. However, chronic conditions such as constrictive pericarditis or recurrent pericardial effusion may require ongoing management and monitoring. Early diagnosis and treatment are key to preventing serious complications like cardiac tamponade, heart failure, or other life-threatening events.