Pericarditis and pericardial effusion: one or two distinct diseases?

Area of Science:

• Cardiology
• Internal Medicine
• Clinical Science

Background:

• Pericardial syndromes encompass acute/recurrent pericarditis, constrictive pericarditis, and chronic pericardial effusion.
• While acute pericarditis is common and often linked to effusions, some effusions lack inflammatory markers.
• Management of pericardial syndromes, especially effusions without inflammation, remains clinically challenging.

Purpose of the Study:

• To review the clinical peculiarities and management strategies for various pericardial syndromes.
• To highlight the challenges in managing pericardial effusions, particularly those without clear inflammatory signs.
• To provide guidance on the follow-up of patients with chronic pericardial effusions.

Main Methods:

• Review of existing literature and clinical guidelines on pericardial syndromes.
• Analysis of diagnostic criteria, including C-reactive protein (CRP) and cardiac magnetic resonance (CMR).
• Discussion of management approaches based on inflammation status and effusion characteristics.

Main Results:

• Acute pericarditis with elevated CRP typically responds to anti-inflammatory treatment.
• Optimal management for pericardial effusions without inflammation (normal CRP, CMR findings) lacks robust evidence.
• Chronic effusions require tailored, long-term follow-up in specialized centers based on clinical factors.

Conclusions:

• Management of pericardial syndromes requires careful consideration of inflammatory markers and clinical presentation.
• Further research is needed to establish evidence-based guidelines for non-inflammatory pericardial effusions.
• Personalized follow-up protocols are crucial for patients with chronic pericardial effusions to monitor stability and manage symptoms.