Makindo Medical Notes

🫀 Pericardial disease refers to a spectrum of conditions affecting the pericardium, the fibrous sac surrounding the heart. The pericardium normally provides mechanical protection, prevents overdistension, and maintains smooth diastolic filling. When diseased, it may become inflamed (pericarditis), fill with fluid (effusion, tamponade), or thicken and scar (constriction). 👉 Clinical importance: pericardial pathology can range from mild chest pain to rapid cardiovascular collapse, making recognition and urgent management essential.

🔬 Pathophysiology

• 🔥 Acute Pericarditis: Inflammation leads to vascular leakage, fibrin deposition, and pain due to irritation of parietal pericardium (somatically innervated by phrenic nerves). Viral infections and autoimmune disorders are common causes.
• 💧 Pericardial Effusion: Fluid accumulates between visceral and parietal layers. Small effusions may be asymptomatic; rapid accumulation (even 200 ml) can impair filling, while slow accumulation (litres) may be tolerated.
• 🚨 Cardiac Tamponade: Pericardial pressure rises > right atrial/ventricular diastolic pressure → impaired venous return → ↓ stroke volume → obstructive shock. Compensated initially by tachycardia, but quickly life-threatening.
• 🧱 Constrictive Pericarditis: Chronic pericardial thickening/calcification → rigid encasement of the heart → impaired diastolic filling and systemic venous congestion. Often follows TB, surgery, or radiation therapy.

📊 Forms of Pericardial Disease

💡 Commentary & Teaching Pearls

• 🔑 Acute pericarditis vs MI: Pericarditis gives widespread concave ST elevation + PR depression; MI changes are regional and convex.
• ⚠️ Beware tamponade: Even small effusions can be fatal if they accumulate rapidly (post-trauma, aortic dissection rupture).
• 🧱 Constrictive pericarditis mimics cirrhosis/heart failure: think pericardium if ascites + raised JVP without pulmonary oedema.
• 🧪 Always consider TB, especially in patients from high-prevalence regions — still a common cause worldwide.
• 🏥 In UK hospitals, colchicine + NSAIDs is now standard for acute pericarditis; steroids are a last resort.
• 📉 Recurrent effusions or unexplained tamponade should raise suspicion for malignancy.

💡 Exam tip: If chest pain is pleuritic, worse lying flat, better leaning forward → think pericarditis. If you hear muffled heart sounds with shock → think tamponade. Always confirm with echocardiography if suspected.