Pericardial Disease Management and Treatment Strategies

Pericardial diseases encompass a spectrum from acute pericarditis and pericardial effusion to recurrent and constrictive forms, each requiring nuanced diagnostic and therapeutic approaches. Initial evaluation relies heavily on clinical assessment and imaging, principally echocardiography and, when available, cardiovascular magnetic resonance, to determine fluid volume, haemodynamic impact and underlying tissue characteristics. First-line therapy for acute and idiopathic pericarditis includes non-steroidal anti-inflammatory drugs or high-dose aspirin combined with colchicine, with corticosteroids reserved for treatment-resistant or intolerant cases. Recurrent pericarditis, often viewed as an autoinflammatory condition, has prompted interest in targeted biological agents, notably interleukin-1 inhibitors, which offer rapid symptom relief and permit steroid tapering. In purulent or malignant effusions, pericardiocentesis remains the preferred immediate intervention, with surgical options such as pericardiectomy or pericardiotomy considered for refractory or constrictive sequelae. Constrictive pericarditis entails surgical pericardiectomy for definitive relief of fibrous restriction. Across all forms, management strategies are informed by risk stratification—incorporating clinical presentation, inflammatory markers and procedural risk—and tailored to resource availability, emphasising timely intervention to prevent morbidity and enhance global outcomes.

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Pericardial Disease Management and Treatment Strategies publication trend

The graph below shows the total number of articles in pericardial disease management and treatment strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Pericardial effusion: Accumulation of excess fluid in the pericardial space.

Cardiac tamponade: Life-threatening compression of the heart by fluid, impairing ventricular filling.

Recurrent pericarditis: Repeated episodes of pericardial inflammation following an initial acute event.

Colchicine: An anti-inflammatory agent that disrupts microtubule assembly to reduce pericardial inflammation.

Interleukin-1 inhibitor: A biologic therapy targeting IL-1 cytokines to interrupt autoinflammatory pathways.

Pericardiocentesis: Percutaneous drainage of pericardial fluid for diagnostic or therapeutic purposes.

References

1. Cardiovascular magnetic resonance in pericardial diseases. Journal of Cardiovascular Magnetic Resonance (2009).
2. Echocardiographic Evaluation of Pericardial Effusion and Cardiac Tamponade. Frontiers in Pediatrics (2017).
3. Efficacy and safety of rilonacept for recurrent pericarditis: results from a phase II clinical trial. Heart (2020).
4. Failure of anti Interleukin-1 β monoclonal antibody in the treatment of recurrent pericarditis in two children. Pediatric Rheumatology (2020).
5. The Therapeutic Role of Interleukin-1 Inhibition in Idiopathic Recurrent Pericarditis: Current Evidence and Future Challenges. Frontiers in Medicine (2017).
6. Clinical Presentation and Outcomes of Acute Pericarditis in a Large Urban Hospital in the United States of America. CHEST Journal (2020).
7. Pericardiocentesis versus pericardiotomy for malignant pericardial effusion: a retrospective comparison. Current Oncology (2015).
8. Pericardiectomy for constrictive pericarditis: single-center experience in China. Journal of Cardiothoracic Surgery (2015).