Pericardial disease
- Lesion
Fluid, blood or inflammation can fill or stiffen the sac around the heart. Fast-filling fluid squeezes the heart; old scar can trap it.
What it is
The pericardial sac can fill with fluid (effusion), blood (haemopericardium), pus or tumour, and its layers can become inflamed (pericarditis). The effect depends on how fast fluid accumulates: a slowly growing large effusion may be tolerated, while a small, rapid one (ruptured infarct, dissection, trauma) causes tamponade. Acute pericarditis is classified by its exudate: serous, fibrinous, purulent, haemorrhagic or caseous. Healing can leave adhesions or a thick, rigid shell that restricts filling (constrictive pericarditis).
Structure
- Fibrinous pericarditis: fibrin strands on both surfaces with neutrophils; organises into adhesions.
- Constrictive pericarditis: obliterated sac, thick fibrous or calcified shell around the heart; myocardium usually small and atrophic.
Acute pericarditis by its exudate
| Exudate | Typical causes | Appearance |
|---|---|---|
| Serous | Viral infection, autoimmune disease, uremia, tumours nearby | Clear fluid with few inflammatory cells |
| Fibrinous and serofibrinous | Myocardial infarction, Dressler, uremia, rheumatic fever, lupus, radiation | Dull, shaggy ‘bread and butter’ surface |
| Purulent (suppurative) | Bacteria, fungi, parasites | Thick creamy pus, red granular serosa |
| Haemorrhagic | Malignancy, tuberculosis, bacterial infection, after surgery | Blood mixed with fibrinous or purulent exudate |
| Caseous | Tuberculosis (rarely fungi) | Caseating granulomas; often leads to constriction |
Clinical notes
- Tamponade: hypotension, raised jugular pressure, muffled heart sounds (Beck triad) and pulsus paradoxus.
- Constriction: right-sided failure signs with Kussmaul sign and a pericardial knock; it can be cured by pericardiectomy.
Test yourself
Think of the answer, then tap the question to see it.
Why can a small haemopericardium be fatal while a large chronic effusion is tolerated?
Rapid accumulation gives the pericardium no time to stretch, so pressure rises and compresses the heart (tamponade).
Which type of pericarditis is typical of tuberculosis?
Caseous pericarditis, which often leads to constrictive pericarditis.
Which pericarditis appears one to three days after a transmural infarct?
A fibrinous (or serofibrinous) pericarditis over the infarcted area.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Pericarditis: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025); Cardiac Tamponade (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.