Controversial issues in the management of pericardial diseases.

The management of pericardial diseases is largely empirical because of the relative lack of randomized trials. The first published guidelines1,2 are a first attempt to organize current knowledge. At present, no specific guidelines have been issued by the American Heart Association and American College of Cardiology. After a literature review including a Medline search with the MeSH terms “pericarditis” and “pericardium,” we identified the following controversial issues related mainly to the management of pericarditis and pericardial effusion: (1) etiological search and hospitalization; (2) role of pericardiocentesis, pericardial biopsy, and pericardioscopy; (3) myopericarditis; (4) use of corticosteroids, nonsteroidal antiinflammatory drugs (NSAIDs), and colchicine; (5) management of refractory cases and long-term outcome; (6) role of pericardiectomy, pericardial window, and other interventional techniques; and (7) management of chronic idiopathic pericardial effusion. At the end of each issue, key points are summarized. Management of most cases is done by general practitioners or different healthcare specialists and does not require specific expertise; nevertheless, incessant and recurrent cases and specific forms (eg, tuberculous pericarditis, neoplastic pericardial disease, autoimmune conditions) require cooperation among specialties (eg, cardiology, infectious diseases, rheumatology, oncology). Specific interventional techniques (eg, pericardioscopy) and pericardiectomy should be performed in referral centers.