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(Circulation. 2006;113:1622-1632.)
© 2006 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Pericardial Disease

William C. Little, MD; Gregory L. Freeman, MD

From the Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC (W.C.L.); and Departments of Medicine and Physiology, University of Texas Health Science Center–San Antonio, South Texas Veteran’s Health Care System, San Antonio, Tex (G.L.F.).

Correspondence to Dr William C. Little, Cardiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1045. E-mail wlittle@wfubmc.edu

Key Words: cardiac tamponade • pericarditis • pericardium

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
In contrast to coronary artery disease, heart failure, valvular disease, and other topics in the field of cardiology, there are few data from randomized trials to guide physicians in the management of pericardial diseases. Although there are no American Heart Association/American College of Cardiology guidelines on this topic, the European Society of Cardiology has recently published useful guidelines for the diagnosis and management of pericardial diseases.¹ Our review focuses on the current state of knowledge and the management of the most important pericardial diseases: acute pericarditis, pericardial tamponade, pericardial constriction, and effusive constrictive pericarditis.

	The Normal Pericardium

 
The pericardium is a relatively avascular fibrous sac that surrounds the heart. It consists of 2 layers: the visceral and parietal pericardium. The visceral pericardium is composed of a single layer of mesothelial cells that are adherent to the cardiac epicardium.^2,3 The parietal pericardium is a fibrous structure that is <2 mm thick and is composed primarily of collagen and a lesser amount of elastin. The 2 layers of the pericardium are separated by a potential space that can normally contain 15 to 35 mL of serous fluid distributed mostly over the atrial-ventricular and interventricular grooves.

The pericardium surrounds the heart and attaches to the sternum, the diaphragm, and the anterior mediastinum and is invested around the great vessels and the venae cavae, serving to anchor the heart in the central thorax. Because of its location, the pericardium may also function as a barrier to infection.

The pericardium is well innervated such that pericardial inflammation may . . . [Full Text of this Article]

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