Skip to Main Content

Chapter 491. Pericardial Diseases

Julien I. E. Hoffman

The pericardium is a 2-layered sac that contains the heart and the proximal parts of the great vessels. The outer surface of the sac is termed the parietal pericardium and is lined by mesothelial cells. The inferior part of the sac is attached to the diaphragm. The inner layer of the sac, also lined by mesothelial cells, is attached to the cardiac surface and is known as the visceral pericardium. A small amount of fluid fills the cavity between the pericardial layers and acts as a lubricant so that the heart can move within the sac. The parietal pericardium has blood and lymphatic vessels. Disorders that affect the pericardium may be primary or secondary to disease elsewhere in the body, including the heart itself.

Whatever the cause, there are only 3 manifestations: acute or chronic inflammation of the pericardial sac in response to injury or accumulation of fluid between the 2 layers—a pericardial effusion with or without a tamponade.

Acute pericarditis has many causes (see Table 491-1). No matter what the cause, the presentation is similar.

Table 491-1 Etiologya of Pericarditis
View Table||Download (.pdf)
Table 491-1 Etiologya of Pericarditis
A. Idiopathic, presumed viral
B. Acute infections:
(1) Viral-coxsackie A and B, echovirus, adenovirus, mumps virus, influenza virus, varicella zoster and vaccinia viruses, Epstein-Barr virus, infectious mononucleosis, psittacosis-lymphogranuloma venereum group, cytomegalovirus, rubella, herpes simplex, human immunodeficiency virus
(2) Bacterial-staphylococci, pneumococci,Haemophilus influenzae, meningococci, streptococci, Salmonella, mycobacteria with HIV infection virus
(3) Mycoplasma
(4) Protozoa—amebae, toxoplasmosis
(5) Rickettsia—Coxiella burnetii
C. Physical causes:
(1) Hemopericardium and pericarditis after chest trauma or cardiac surgery
(2) Serous or serosanguineous effusions after cardiac trauma, cardiac surgery, or myocardial infarctions; all may result from autoimmune mechanisms
(3) Perforation of right atrium by indwelling lines, even soft silastic catheters
(4) Chest well radiation
D. Chronic infections:
(1) Tuberculosis, actinomycosis, nocardiasis
(2) Fungi—histoplasmosis, coccidiomycosis, Candida spp, aspergillosis, blastomycosis
(3) Hydatid disease
E. Associated with anasarca in congestive heart failure, nephrosis, or cirrhosis of the liver
F. Vasculitis syndromes, especially systemic lupus erythematosus, rheumatoid arthritis, and rheumatic fever, but also scleroderma, polyarteritis, Wegener granulomatosis, Behçet syndrome, Reiter syndrome, Whipple disease
G. Metabolic disorders—uremia, myxedema, gout
H. Hemodialysis
I. Congenital heart disease, cardiomyopathy
J. Benign and malignant cavity
K. Drugs—hydralazine, procainamide, phenytoin, isoniazid, phenylbutazone, methysergide, penicillin, anticoagulants, practolol, minoxidil
L. Certain anemias—sickle cell disease, thalassemia, congenital aplastic anemia
M. Miscellaneous—dissecting aneurysm, acute, pancreatitis, sarcoidosis, multiple myeloma, amyloidosis, Kawasaki syndrome, ulcerative colitis

aThe most commone causes are printed in bold type.

  1. 1. Chest pain is usually precordial and often referred to the neck, shoulder, or epigastrium. The pain is sharp or burning and is usually made better by sitting up and leaning forward. It is made worse by taking in a deep breath because inspiration lowers the diaphragm, pulls the pericardial sac down, and narrows it, thereby causing the 2 ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close