Pericarditis and other pericardial disease
How inflammation roughens the pericardium and causes pain, a rub and widespread ST elevation, why fluid that gathers fast compresses the heart (tamponade), and how a scarred pericardium constricts filling.
By the end, you can
- Describe the layers of the pericardium and why its fibrous layer stretches only slowly.
- List the main causes of acute pericarditis and relate the fibrinous exudate to the friction rub, the pain and the ECG changes.
- Explain why the speed of fluid collection matters more than its volume, and how tamponade causes Beck’s triad and pulsus paradoxus.
- Explain how constrictive pericarditis limits filling and how it differs from tamponade.
- Recognise the classic appearances, criteria and tests of pericardial disease, and explain how each main treatment acts on the mechanism.
What it is
Pericarditis is inflammation of the pericardium, the sac around the heart. It can be acute, recurrent or chronic, and it can leave fluid in the sac (pericardial effusion), which compresses the heart when its pressure rises (cardiac tamponade), or scar that encases it (constrictive pericarditis).
3 types to tell apart
- Acute pericarditis
- Inflammation of the serous layers, usually fibrinous, with pain, a friction rub and ECG changes; most cases are viral or idiopathic.
- Pericardial effusion and tamponade
- Fluid, blood or pus in the sac; it compresses the heart when it gathers faster than the fibrous layer can stretch.
- Constrictive pericarditis
- A thickened, fibrous and often calcified pericardium that stops the ventricles filling, months to years after inflammation.
Normal function
The pericardium: a fibrous bag and a serous sac
The heart sits in a two-layered sac. The outer is tough, inelastic collagen, fused with the great vessels above and the diaphragm below. Inside it the lines the fibrous layer as the parietal layer, then turns back at the roots of the great vessels to cover the heart itself as the visceral layer, the epicardium.
Between the two serous layers lies the pericardial cavity, a slit holding a thin film of fluid, normally less than about 50 mL. It is filtered from plasma and lets the beating and glide without friction.
The fibrous layer barely stretches over minutes, so it stops the heart over-filling suddenly and links the filling of the two sides: in a full sac, whatever space one ventricle gains, the other loses. Pressure in the cavity follows chest pressure and falls with each breath in, which draws more blood into the right heart. The parietal layer is supplied by the phrenic nerves, so its pain can be felt in the neck and shoulder.
Underlying change · Step 1 of 4
Acute pericarditis: causes and the fibrinous surface
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 2 of 4
Pericardial effusion: fluid in a sac that stretches slowly
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 3 of 4
Cardiac tamponade: the heart cannot fill
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 4 of 4
Constrictive pericarditis: a rigid shell
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .