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Medical therapy of pericardial diseases: Part I: Idiopathic and infectious pericarditis

Imazio, Massimo; Brucato, Antonio; Mayosi, Bongani M; Derosa, Francesco Giuseppe; Lestuzzi, Chiara; Macor, Antonio; Trinchero, Rita; Spodick, David H; Adler, Yehuda

Journal of Cardiovascular Medicine: October 2010 - Volume 11 - Issue 10 - p 712–722
doi: 10.2459/JCM.0b013e3283340b97
Review article

The treatment of pericardial diseases is largely empirical because of the relative lack of randomized trials compared with other cardiovascular diseases. The main forms of pericardial diseases that can be encountered in the clinical setting include acute and recurrent pericarditis, pericardial effusion with or without cardiac tamponade, and constrictive pericarditis. Medical treatment should be targeted at the cause of the disease as much as possible. However, the cause of pericardial diseases may be varied and depends on the prevalence of specific diseases (especially tuberculosis). The search for an etiology is often inconclusive, and most cases are classified as idiopathic in developed countries where tuberculosis is relatively rare, whereas a tuberculous etiology is often presumed in developing countries where tuberculosis is endemic. The aim of the present article is to review current medical therapy for pericardial diseases, highlighting recent significant advances in clinical research, ongoing challenges and unmet needs. Following a probabilistic approach, the most common causes are considered (idiopathic, viral, tuberculous, purulent, connective tissue diseases and neoplastic pericardial disease). In this article, the therapy of idiopathic and more common forms of infectious pericarditis (viral and bacterial) is reviewed.

aCardiology Department, Maria Vittoria Hospital, Torino, Italy

bInternal Medicine Department, Ospedali Riuniti, Bergamo, Italy

cDepartment of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa

dUniversity Infectious Diseases Department, Amedeo di Savoia Hospital, University of Torino, Italy

eCardiology Department, National Cancer Institute, Aviano, Italy

fInfectious Risk Prevention SC–ASL TO2, USA

gDepartment of Medicine, St. Vincent Hospital, University of Massachusetts, Worcester, Massachusetts, USA

hChaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv and Misgav ladach Hospital, Jerusalem, Kupat Holim Meuhedet, Israel

Received 19 April, 2009

Revised 16 September, 2009

Accepted 9 October, 2009

Correspondence to Massimo Imazio, MD, FESC, Cardiology Department, Maria Vittoria Hospital, Torino, Italy Tel: +39 011 4393391; fax: +39 011 4393334; e-mail:

© 2010 Italian Federation of Cardiology. All rights reserved.