Skip to main content
SpringerLink
Log in

Diagnostik und Therapie der Perikarditis und des Perikardergusses

Diagnostics and therapy of pericarditis and pericardial effusion

  • CME Zertifizierte Fortbildung
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

In diesem Beitrag werden Diagnostik, Differenzialdiagnostik, multimodale Bildgebung sowie medikamentöse und invasiv diagnostische Therapie der akuten und chronischen Perikarditis, der konstriktiven Perikarditis, des Perikardergusses und der Herztamponade unter ätiologischen Gesichtspunkten und in Anlehnung an die Leitlinie der European Society of Cardiology (ESC) beschrieben. Ausgangspunkt des klinischen Entscheidungsbaums ist der symptomatische Patient mit echokardiographisch nachweisbarem Perikarderguss. Im Vordergrund der Diagnostik steht die ätiopathogenetische Einordnung der Perikarderkrankung, die klinisches Bild, Verlauf, Therapie und Prognose prägen. Die infektiöse Perikarditis (viral, bakteriell oder tuberkulös) wird von der sterilen autoreaktiven Perikarditis und vom neoplastischen Perikarderguss durch Ergusszytologie sowie (immun-)histologische und molekulare Untersuchungen der Perikard- und Epikardbiopsie abgegrenzt. Hierzu leistet die Perikardioskopie zur Erkennung suspekter Areale einen wichtigen Beitrag. Intraperikardiale Cisplatingabe bei neoplastischem Perikarderguss und Instillation von Triamcinolon bei autoreaktiver Perikarditis verhindern ebenso wie eine mehrmonatige Behandlung mit Colchicin in vielen Fällen Rezidive.

Abstract

This article describes the diagnostics, differential diagnostics, multimodal imaging, medicinal and invasive diagnostic therapy of acute and chronic pericarditis, constrictive pericarditis, pericardial effusion and cardiac tamponade under etiological aspects and on the basis of the guidelines of the European Society of Cardiology (ESC). The starting point of the decision tree is the symptomatic patient with echocardiographic evidence of pericardial effusion. The principle feature of the diagnostics is the etiopathogenetic allocation of the pericardial disease which influences the clinical picture, course therapy and prognosis. Infectious pericarditis (e.g. viral, bacterial and tuberculous) is differentiated from sterile autoreactive pericarditis and from neoplastic pericardial effusion by the cytology of the effusion and immunohistological and molecular investigations of the pericardial and epicardial biopsies. Pericardioscopy plays an important role in the recognition of suspicious areas. In many cases intrapericardial administration of cisplatin for neoplastic pericardial effusion and instillation of triamcinolone for autoreactive pericarditis prevent recurrence just as a treatment of several months with colchicine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9

Literatur

  1. Maisch B, Seferović PM, Ristić AD et al (2004) Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology. Eur Heart J 25:587–610

    Article  PubMed  Google Scholar 

  2. Ristić AD, Imazio M, Adler Y et al (2014) Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 35:2279–2284

    Article  PubMed  Google Scholar 

  3. Halpern DG, Argulian E, Briasoulis A et al (2012) A novel pericardial effusion scoring index to guide decision for drainage. Crit Pathw Cardiol 11:85–88

    Article  PubMed  Google Scholar 

  4. Imazio M, Mayosi BM, Brucato A et al (2010) Triage and management of pericardial effusion. J Cardiovasc Med (Hagerstown) 11:928–935

    Article  Google Scholar 

  5. Maisch B (2004) Perikarderkrankungen. In: Classen M, Diehl V, Kochsiek K (Hrsg) Innere Medizin, 5. Aufl. Urban & Fischer, München, S 354–362

  6. Maisch B, Ristić AD (2001) Perikarditis. In: Hombach V (Hrsg) Handbuch der interventionellen Kardiologie und Kardiovaskularchirurgie, Kap. 46. Schattauer, Ulm

  7. Spodick DH (2003) Acute cardiac tamponade. N Engl J Med 349:684–690

    Article  PubMed  Google Scholar 

  8. Shabetai R (2004) Pericardial effusion: haemodynamic spectrum. Heart 90:255–256

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Maisch B, Ristić AD, Seferovic PM, Tsang TSM (2011) Interventional pericardiology. Springer, Heidelberg

  10. Syed FF, Ntsekhe M, Mayosi BM, Oh JK (2013) Effusive-constrictive pericarditis. Heart Fail Rev 18:277–288

    Article  PubMed  Google Scholar 

  11. Maisch B (2014) Akute und chronische Perikarditis. In: Lehnert H, Schuster HP (Hrsg) Innere Medizin. Springer, Heidelberg

  12. Maisch B, Ristić AD (2011) Pericardial diseases. In: Vincent JL, Abrahahm E, Moore FA et al (eds) Textbook of critical care, 6th edn. Elsevier Saunders, Philadelphia, pp 639–646

  13. Maisch B, Rupp H, Ristić AD, Pankuweit S (2013) Pericardioscopy and epi- and pericardial biopsy – a new window to the heart improving etiological diagnoses and permitting targeted intrapericardial therapy. Heart Fail Rev 18:317–328

    Article  PubMed  Google Scholar 

  14. Imazio M, Brucato A, Maestroni S et al (2011) Prevalence of C-reactive protein evalation and time course of normalization in acute pericarditis: implications for the diagnosis, therapy, and prognosis of pericarditis. Circulation 123:1092–1097

    Article  CAS  PubMed  Google Scholar 

  15. Imazio M, Brucato A, Trinchero R, Adler Y (2009) Diagnosis and management of pericardial diseases. Nat Rev Cardiol 6:743–751

    Article  PubMed  Google Scholar 

  16. Maisch B (2013) Pericardial diseases in the era of imaging, biomarkers and molecular diagnosis. Heart Fail Rev 18:251–254

    Article  PubMed  Google Scholar 

  17. Pankuweit S, Stein A, Karatolios K et al (2013) Viral genomes in the pericardial fluid and in peri- and epicardial biopsies from a German cohort of patients with large to moderate pericardial effusion. Heart Fail Rev 18:329–336

    Article  CAS  PubMed  Google Scholar 

  18. Ristić AD, Pankuweit S, Maksimović R et al (2013) Pericardial cytokines in neoplastic, autoreactive, and viral pericarditis. Heart Fail Rev 18:345–354

    Article  PubMed  Google Scholar 

  19. Sagrista-Sauleda J, Angel J, Permanyer-Miralda G et al (1999) Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med 341:2054–2059

    Article  CAS  PubMed  Google Scholar 

  20. Sagrista-Sauleda J, Barrabes JA, Permanyer-Miralda G et al (1993) Purulent pericarditis: review of a 20-year experience in a general hospital. J Am Coll Cardiol 22:1661–1665

    Article  CAS  PubMed  Google Scholar 

  21. Shabetai R (1990) Acute pericarditis. Cardiol Clin 8:639–644

    CAS  PubMed  Google Scholar 

  22. Spodick DH (1997) The pericardium: a comprehensive textbook. Marcel Dekker, New York, pp 260–290

  23. Maisch B, Herzum M (1999) Erkrankungen des Perikards. In: Paumgartner G, Riecker G (Hrsg) Therapie Innerer Krankheiten. Springer, Heidelberg

  24. Tsang TS, Enriquez-Sarano M, Freeman WK et al (2002) Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 77:429–436

    Article  PubMed  Google Scholar 

  25. Tsang TS, Freeman WK, Barnes ME et al (1998) Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience. J Am Coll Cardiol 32:1345–1350

    Article  CAS  PubMed  Google Scholar 

  26. Veress G, Feng D, Oh JK (2013) Echocardiography in pericardial diseases: new developments. Heart Fail Rev 18:267–276

    Article  PubMed  Google Scholar 

  27. Oh JK, Tajik AJ, Seward JB et al (1994) Diagnostic role of Doppler echocardiography in constrictive pericarditis. J Am Coll Cardiol 23:154–162

    Article  CAS  PubMed  Google Scholar 

  28. Horowitz MS, Schultz CS, Stinson EB et al (1974) Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation 50:239–247

    Article  CAS  PubMed  Google Scholar 

  29. Alter P, Figiel JH, Rupp TP et al (2013) MR, CT, and PET imaging in pericardial disease. Heart Fail Rev 18:289–306

    Article  CAS  PubMed  Google Scholar 

  30. Cosyns B, Plein S, Nihoyanopoulos P et al (2014) European Association of Cardiovascular Imaging (EACVI) position paper: multimodality imaging in pericardial disease. Eur Heart J Cardiovasc Imaging [Epub ahead of print]

  31. Karatolios K, Pankuweit S, Maisch B (2013) Diagnostic value of biochemical biomarkers in malignant and non-malignant pericardial effusion. Heart Fail Rev 18:337–344

    Article  CAS  PubMed  Google Scholar 

  32. Ntsekhe M, Mayosi BM (2013) Tuberculous pericarditis with and without HIV. Heart Fail Rev 18:367–373

    Article  PubMed  Google Scholar 

  33. Ristić AD, Wagner HJ, Maksimović R, Maisch B (2013) Epicardial halo phenomenon: a guide for pericardiocentesis? Heart Fail Rev 18:307–316

    Article  PubMed  Google Scholar 

  34. Fagan SM, Chan KI (1999) Pericardiocentesis. Blind no more! Chest 116:275–276

    Article  CAS  PubMed  Google Scholar 

  35. Cooper LT, Baughman KL, Feldman AM et al (2007) The role of endomyocardial biopsy in the management of cardiovascular disease. A scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 28:3076–3093

    Article  PubMed  Google Scholar 

  36. Imazio M, Adler Y (2013) Treatment with aspirin, NSAID, corticosteroids, and colchicine in acute and recurrent pericarditis. Heart Fail Rev 18:355–360

    Article  CAS  PubMed  Google Scholar 

  37. Spodick DH (1986) Safety of ibuprofen for acute myocardial infarction pericarditis. Am J Cardiol 57:896

    Google Scholar 

  38. Adler Y, Finkelstein Y, Guindo J et al (1998) Colchicine treatment for recurrent pericarditis: a decade of experience. Circulation 97:2183–2185

    Article  CAS  PubMed  Google Scholar 

  39. Brucato A, Cimaz R, Balla E (2000) Prevention of recurrences of corticosteroid-dependent idiopathic pericarditis by colchicine in an adolescent patient. Pediatr Cardiol 21:395–397

    Article  CAS  PubMed  Google Scholar 

  40. Imazio M, Bobbio M, Cecchi E et al (2005) Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation 112:2012–2016

    Article  CAS  PubMed  Google Scholar 

  41. Imazio M, Bobbio M, Cecchi E et al (2005) Colchicine as first choice therapy for recurrent pericarditis: results of the CORE (COlchicine for REcurrent pericarditis) trial. Arch Intern Med 165:1987–1991

    Article  CAS  PubMed  Google Scholar 

  42. Imazio M, Brucato A, Cemin R et al (2011) Colchicine for recurrent pericarditis (CORP): a randomized trial. Ann Intern Med 155:409–414

    Article  PubMed  Google Scholar 

  43. Imazio M, Brucato A, Cumetti D et al (2008) Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation. Circulation 118:667–671

    Article  CAS  PubMed  Google Scholar 

  44. Maisch B, Berg PA, Kochsiek K (1979) Clinical significance of immunopathological findings in patients with post-pericardiotomy syndrome. I. Relevance of antibody pattern. Clin Exp Immunol 38:189–197

    CAS  PubMed Central  PubMed  Google Scholar 

  45. Maisch B, Schuff-Werner P, Berg PA et al (1979) Clinical significance of immunopathological findings in patients with post-pericardiotomy syndrome. II. The significance of serum inhibition and rosette inhibitory factors. Clin Exp Immunol 38:198–203

    CAS  PubMed Central  PubMed  Google Scholar 

  46. Meurin P, Lelay-Kubas S, Pierre B et al (2014) Colchicine for post-operative pericardial effusion: the Post-Operative Pericardial Effusion (POPE-2) study. A multicenter, double-blind, randomized trial. European Society of Cardiology 2014 Congress; August 31, 2014; Barcelona, Spain. Hot Line 889

  47. Imazio M, Brucato A, Ferrazzi P et al (2011) Colchicine reduces postoperative atrial fibrillation: results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) atrial fibrillation substudy. Circulation 124:2290–2295

    Article  CAS  PubMed  Google Scholar 

  48. Imazio M, Brucato A, Ferrazzi P et al (2014) Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA 312:1016–1023

    Article  CAS  PubMed  Google Scholar 

  49. Maisch B, Ristić AD, Pankuweit S (2002) Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone: the way to avoid side effects of systemic corticosteroid therapy. Eur Heart J 23:1503–1508

    Article  CAS  PubMed  Google Scholar 

  50. Colleoni M, Martinelli G, Beretta F et al (1998) Intracavitary chemotherapy with thiotepa in malignant pericardial effusion: an active and well tolerated regimen. J Clin Oncol 16:2371–2376

    CAS  PubMed  Google Scholar 

  51. Aggeli C, Pitsavos C, Brili S et al (2000) Relevance of adenosine deaminase and lysozyme measurements in the diagnosis of tuberculous pericarditis. Cardiology 94:81–85

    Article  CAS  PubMed  Google Scholar 

  52. Burgess LJ, Reuter H, Carstens ME et al (2002) The use of adenosine deaminase and interferon-gamma as diagnostic tools for tuberculous pericarditis. Chest 122:900–905

    Article  CAS  PubMed  Google Scholar 

  53. Mayosi BM, Ntsekhe M, Bosch J et al (2014) Prednisolone and Mycobacterium indicus pranii in tuberculous pericarditis. N Engl J Med 371:1121–1130

    Article  CAS  PubMed  Google Scholar 

  54. Scholten C, Staudacher M, Girsch W et al (1998) A novel therapeutic strategy for the management of idiopathic chylopericardium and chylothorax. Surgery 123:369–370

    Article  CAS  PubMed  Google Scholar 

  55. Denfield SW, Rodriguez A, Miller-Hance WC et al (1989) Management of postoperative chylopericardium in childhood. Am J Cardiol 63:1416–1418

    Article  CAS  PubMed  Google Scholar 

  56. Cho YH, Schaff HV (2013) Surgery for pericardial disease. Heart Fail Rev 18:375–387

    Article  PubMed  Google Scholar 

  57. Erbel R, Alfonso F, Boileau C et al (2001) Diagnosis and management of aortic dissection. Eur Heart J 22:1642–1681

    Article  CAS  PubMed  Google Scholar 

  58. Maisch B (2013) Alcohol ablation of pericardial cysts under pericardioscopical control. Heart Fail Rev 18:361–366

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. B. Maisch gibt an, dass er Mitinhaber eines Patents für den Zugang zum Perikard auch bei kleinen oder fehlenden Ergüssen ist (Marburg Attacher). A.D. Ristić gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Fachbereich Medizin der Philipps-Universität Marburg, Feldbergstr. 45, 35043, Marburg, Deutschland

    B. Maisch

  2. Universität Belgrad, Belgrad, Serbien

    A.D. Ristić

Authors
  1. B. Maisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A.D. Ristić
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Maisch.

Additional information

Dieser Beitrag nimmt Bezug auf frühere deutsch- und englischsprachige Publikationen des Autors (Literaturverzeichnis 1, 5, 6, 9, 11, 12, 23) und aktualisiert die vorgängigen Veröffentlichungen des Autors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maisch, B., Ristić, A. Diagnostik und Therapie der Perikarditis und des Perikardergusses. Herz 39, 837–856 (2014). https://doi.org/10.1007/s00059-014-4167-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-014-4167-1

Schlüsselwörter

Keywords

Search

Navigation