ABSTRACT

The diagnosis of pericardial diseases

Pericardial diseases have various acute or chronic causes, and their main symptoms are pericarditis, pericardial effusion and constrictive pericarditis. Echocardiography is crucial for the diagnosis of changes in the pericardium and, according to the ESC standards, it is indicated for use in suspected pericarditis, cardiac tamponade and constrictive pericarditis. Echocardiography allows visualizing fluid in the pericardial sac behind the heart cavities and in the pericardial sinuses, according to the anatomical site, and its amount can also be roughly determined. Clinical symptoms vary according to the dynamics of fluid accumulation and fluid volume. A critical situation is cardiac tamponade, i.e. insufficient filling of the heart chambers due to the pressure of the fluid in the pericardium compressing the orifices of the cardiac veins. Tamponade is a clinical diagnosis; the leading symptom is a significant drop in blood pressure, which can even lead to shock. Numerous echocardiographic signs, resulting from e.g. the separation of the heart from the pressures prevailing in the chest, indicate the possibility of tamponade or they can help to confirm it if there are any doubts. Tamponade can be associated with the presence of a substantial amount of fluid or a small amount of fluid when it accumulates quickly. Tamponade should be decompressed by puncturing the pericardial sac, and echocardiography is an excellent method to monitor this procedure. Constrictive pericarditis, which results from pericardial stiffening, is a pericardial disease that is predominantly fluid-free. It can be a very chronic process or a transient phenomenon in the course of inflammation or irritation. The hemodynamic effects of constrictive pericarditis are very similar to those of tamponade as the isolation of the heart from the pressures in the chest is similar. The diagnosis can be established based on the characteristic echocardiographic symptoms, such as those related to tamponade and identified mostly based on tissue Doppler analysis.