This document from the Universidad Tecnica de Machala provides information on diseases of the pericardium, including acute pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis. It defines each condition, discusses their etiology, clinical presentation, diagnosis, and treatment. The pericardium is the membrane surrounding the heart, and diseases can occur when it becomes inflamed or fluid accumulates in the pericardial sac. The document aims to educate medical students on pathologies of the pericardium.

1. UNIVERSIDAD TECNICA DE MACHALA
ACADEMIC UNIT OF CHEMICAL
SCIENCES AND HEALTH
MEDICINE SCHOOL
ENGLISH
DISEASES OF THE
PERICARD
STUDENTS
William Cruz
Kevin Herrera
Jorge Pacheco
Angie Chamba
Sonia Quijilema
TEACHER:
Mgs. Barreto Huilcapi Lina Maribel
CLASS:
EIGHTH SEMESTER ‘’A’’
Machala, El Oro
2018

2. DISEASES OF THE PERICARD
The pericardium is a membrane that covers the heart like a sac. It is formed by
two leaves, the parietal leaf and the visceral leaf between which there is a small
amount of liquid. Where we can find the following pathologies:
ACUTE PERICARDITIS
 Concept.- Acute inflammation of the pericardium that may or may not
occur with pericardial effusion or cardiac tamponade.
 Etiology.- Infectious pericarditis; which can be: viral, tuberculous,
purulent and other types. Pericarditis due to immunological mechanism
and vasculitis. Pericarditis after myocardial infarction. Pericarditis
postpericardiotomy. Pericarditis associated with metabolic diseases.
Neoplastic pericarditis. Pericarditis due to physical agents; such as
radiotherapy.
 Clinical Table.- The triad is presented. 1. Thoracic pain; it is located in
the anterior plane of the thorax and often radiates to the supraclavicular
region, neck and shoulders, increases with inspiration and with cough,
which can improve with sitting. 2. Pericardial friction; it can be listened to

3. better in the mesocardium, it can be confused with murmur and can
increase with inspiration. 3. Fever; common but not constant. There may
also be a dyspnea sensation.
 Complementary Explorations.- Electrocardiogram, chest x-ray,
echocardiogram and laboratory tests (leukocytosis and elevation of the
ESR and CRP).
 Prognosis.- According to the etiology. Recurrences can occur and
idiopathic ones are cured in their majority.
 Treatment.- Symptomatic; Bed rest and acetylsalicylic acid 0.5-1 g every
6h. Idiopathic pericarditis; Colchicine 1-2 mg / day. and in pericarditis
with etiology, it will be done according to the one that presents.
PERICARDIAL EFFUSION
 Concept.- The pericardial cavity contains, under normal conditions, about
15-50 mL of fluid, which is why it is considered pericardial effusion if it
exceeds this amount.
 Etiology. - The most frequent is acute pericarditis. The massive chronic
effusion so-called because it lasts more than three months and is above
20mm on the electrocardiogram, is generally idiopathic but may be due to
hypothyroidism.
 SINGS AND SYMPTONS.- In abundant effusions the auscultation may
be normal and the beating of the cardiac tip can be palpated.
 Diagnosis.- On chest radiography, cardiomegaly can be seen. In the
echocardiogram, an echo-free space is shown in the anterior and posterior
sacs or around the heart, allowing the spill to be quantified in light (free
space in the anterior sac plus posterior sac less than 10mm), moderate
(between 10 and 20mm), and serious (greater than 20mm), it is also
appreciated if the presence of flanges or fibrin is also septate or free. CT,
MRI and ECG are very helpful.
 Prognosis.- According to its etiology. Idiopathic massive chronic
pericardial effusion may be complicated by cardiac tamponade.

4.  Treatment.- Pericardiocentesis is performed and if it is recurrent, a wide
pericardiectomy will be performed.
CARDIAC TAMPONADE
 Concept.- Clinical-hemodynamic syndrome caused by compression of the
heart by a tension pericardial effusion that hinders the diastolic filling of
the heart.
 Etiology.- As practically all the clinical entities that are accompanied by
pericardial effusion may present with tamponade, although pericarditis is
the most frequent cause.
 SINGS AND SYMPTONS.- Chest pain, fever, malaise, dyspnea,
restlessness, venous hypertension, jugular engorgement accompanied by
jugular hyperpulsility, hepatomegaly, and presence of paradoxical arterial
pulse.
 Complementary Explorations.- Echocardiography shows exaggerated
respiratory variations of the mitral flow and the end-diastolic inspiratory
inversion of the vena cava flow. Electrocardiogram, shows a generalized
low voltage. Cardiac catheterization, shows registration of intrapericardial
pressure and intracavitary pressures.
 Differential Diagnosis.- It should be differentiated from; congestive heart
failure, exudative - acute and subacute constrictive pericarditis, extrinsic
cardiac compression, right ventricular infarction, cardiogenic shock and
acute cor pulmonale.
 Treatment: Liquid evacuation through pericardiocentesis (subxiphoid or
precordial).
CONSTRICTIVE PERICARDITIS
 Concept.- Characterized by a limitation of the ventricular filling, caused
by thickening, fusion, and sometimes calcification of the leaves of the
pericardium that prevents normal ventricular diastolic relaxation.
 Etiology.- In the majority the etiology is unknown, however the acute
pericarditis can evolve towards the constrictive one.

5.  Sings and Symptons.- consists of; dyspnea, discomfort of edema of lower
extremities and abdominal swelling, asthenia, infrequent chest pain,
hepatomegaly, ascites and jugular engorgement.
 Diagnosis.- Analysis of the jugular venous pulse, pulmonary hypertension,
and infrequently paradoxical pulse is presented.
 Complementary Explorations.- Electrocardiogram, will present flattened
or negative T waves. Chest x-ray, there is extensive pericardial
calcification that is better seen in the lateral projection and with an image
intensifier, cardiomegaly is seen and in some cases pleural effusion.
Echocardiogram may show diastolic horizontalization of the pericardial
echo, increase in its density, and anterior protodiastolic movement of the
interventricular septum. CT and MR, allow to appreciate the thickness of
the pericardium as well as calcification. Cardiac catheterization, presents
certain hemodynamic alterations.
 Differential Diagnosis.- Chronic constrictive pericarditis, differs from;
liver cirrhosis, restrictive cardiomyopathy, mitral stenosis, dilated
cardiomyopathy, right atrial tumor, chronic cor pulmonale, and superior
vena cava syndrome.
 Treatment.- Consists in the practice of a pericardiectomy, as extensive as
possible. Medical treatment with diuretics is only indicated in the forms
with obvious venous hypertension, which can not be treated by
pericardiectomy.
BIBLIOGRAPHIC REFERENCE:
 SAULEDA, J. Sagrista. Diseases of the Pericardium.
 In: ROZMAN and FARRERAS. Internal Medicine. Spain, Elseiver, 2016.
pp 527-535