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(Circulation. 2002;105:2939.)
© 2002 American Heart Association, Inc.

Clinician Update

Management of Effusive and Constrictive Pericardial Heart Disease

Brian D. Hoit, MD

From the Department of Medicine, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio.

Correspondence to Brian D. Hoit, MD, Division of Cardiology, Case Western Reserve University, 11100 Euclid Ave, MS 5038, Cleveland, OH 44106. E-mail bdh6@po.cwru.edu

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

	Introduction

 
Case study: A 69-year-old white male was referred for transesophageal echocardiography (TEE) two days after urgent coronary artery bypass grafting. In the first 24 postoperative hours, pleural and pericardial drainage was nearly 3 L, during which time the blood pressure was supported with inotropic agents. The next day, chest tube drainage was minimal, a transthoracic echocardiogram was unremarkable, and the patient was extubated. Shortly thereafter, the patient became hypotensive and dyspneic. TEE revealed a large loculated effusion with linear adhesions and thrombus that compressed both atria, as well as a large pleural effusion. There was marked respiratory variation in Doppler velocities across the tricuspid and mitral valves. At thoracotomy, 1 L of blood was removed from the pericardial space, bleeding at the site of aortic cannulation was sutured, and the patient made an uneventful recovery.

Treatment of effusive and constrictive pericardial disease is often simple and gratifying, but frustration and unforeseen challenges await the unwary clinician. The symptoms and signs of pericardial disease, at times unmistakable (as in the patient described above), may be overshadowed by extracardiac manifestations of a systemic disorder; at other times, they are insidious and conceal their true nature. Pericardial constriction mimics hepatic cirrhosis and myocardial failure and may be virtually indistinguishable from restrictive cardiomyopathy. Another important problem is the lack of placebo-controlled trials from which appropriate therapy may be selected and of guidelines that assist in important clinical decisions; as a result, the practitioner must rely heavily on clinical judgment. Finally, therapeutic options in most . . . [Full Text of this Article]

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