10th May 2025

Diagnosis

The diagnosis of pericardial disease should be a deduced from a combination of:

Thorough clinical history (including relevant risk factors)
Signs and symptoms on physical examination
Simple tests such as an ECG, biochemistry profiles
Imaging modalities such as echocardiography


	Pericarditis	Cardiac Tamponade	Constrictive Pericarditis
Clinical history	Acute onset of retrosternal chest pain – caused by irritation of the parietal layers’ rich innervation Classically pleuritic in nature, eased by leaning forward and sitting up Radiation of pain to the trapezius muscle – referred pain from pericardium via the phrenic nerve	Can be insidious in nature Chest pain, palpitations, shortness of breath, cough Dizziness, syncope, altered mental status	Often present with chronic symptoms Volume overload due to venous congestion Fatigue, exertional dyspnoea History of cardiac surgery, TB, or malignancy
Physical examination	Pericardial friction rub at lower left sternal edge Can still be heard when patient holds their breath (distinguishing it from a pleural rub) Fever, systemically unwell	Beck’s triad – hypotension, jugular venous distension, and muffled heart sounds Pulsus paradoxus Ewart sign – area of dullness JVP waveform X descent is prominent Y descent is absent	Ascites, Congestive Hepatomegaly Pericardial knock – sudden abrupt ‘knock’ after the second heart sound – sudden termination of ventricular inflow from the encasing pericardium Kussmaul sign – a paradoxical elevated in JVP and pressure during inspiration
ECG	Diffuse ST elevation (typically concave up) and depression of the PR segment Likely Sinus Tachycardia	Sinus Tachycardia Electrical alternans – swinging of the heart within the fluid filled pericardium	Low voltage QRS Generalised T wave flattening or inversion
Biochemistry	Raised WCC – if high poor prognosis Raised CRP – useful in monitoring disease activity and response to therapy High urea in uraemic cause High Troponin in 30%-70% + raised CK-MB Autoimmune Assay Viral Assay Consideration of Blood cultures	FBC – trauma related could be low Hb Raised WCC if infection related Autoimmune Assay Viral Assay	Autoimmune Assay Viral Assay Low BNP (way to differentiate it between restrictive cardiomyopathy)
Echo	May show pericardial effusion (See figure 1)	Essential for evaluation Large pericardial effusion Right ventricle diastolic collapse No collapsing IVC – see Fig 2 + 3	Respirophasic septal shifting Exaggerated ventricular interdependence Myocardial tethering

Pericarditis

Cardiac Tamponade

Constrictive Pericarditis

Clinical history

Acute onset of retrosternal chest pain – caused by irritation of the parietal layers’ rich innervation

Classically pleuritic in nature, eased by leaning forward and sitting up

Radiation of pain to the trapezius muscle – referred pain from pericardium via the phrenic nerve

Can be insidious in nature

Chest pain, palpitations, shortness of breath, cough

Dizziness, syncope, altered mental status

Often present with chronic symptoms

Volume overload due to venous congestion

Fatigue, exertional dyspnoea

History of cardiac surgery, TB, or malignancy

Physical examination

Pericardial friction rub at lower left sternal edge

Can still be heard when patient holds their breath (distinguishing it from a pleural rub)

Fever, systemically unwell

Beck’s triad – hypotension, jugular venous distension, and muffled heart sounds

Pulsus paradoxus

Ewart sign – area of dullness

JVP waveform

X descent is prominent
Y descent is absent

Ascites, Congestive

Hepatomegaly

Pericardial knock – sudden

abrupt ‘knock’ after the second heart sound – sudden

termination of ventricular

inflow from

the encasing pericardium

Kussmaul sign – a

paradoxical elevated in

JVP and pressure during

inspiration

ECG

Diffuse ST elevation

(typically concave up) and depression of the PR

segment

Likely Sinus Tachycardia

Sinus Tachycardia

Electrical alternans –

swinging of the heart

within the fluid filled

pericardium

Low voltage QRS

Generalised T wave flattening or inversion

Biochemistry

Raised WCC – if high

poor prognosis

Raised CRP – useful in

monitoring disease activity and response to therapy

High urea in uraemic cause

High Troponin in 30%-70% + raised CK-MB

Autoimmune Assay

Viral Assay

Consideration of Blood

cultures

FBC – trauma related could be low Hb

Raised WCC if infection

Autoimmune Assay

Viral Assay

Autoimmune Assay

Viral Assay

Low BNP (way to differentiate it between restrictive cardiomyopathy)

Echo

May show pericardial

effusion (See figure 1)

Essential for evaluation

Large pericardial effusion

Right ventricle diastolic collapse

No collapsing IVC – see Fig 2 + 3

Respirophasic septal shifting

Exaggerated ventricular

interdependence

Myocardial tethering

Table 2: describes the findings for each pericardial disease condition

Complete Guide to Clinical Genetics ST3 Application and Recruitment (2027)

Written by Medibuddy. Last updated: October 2026. Clinical Genetics is

Clinical Genetics ST3

Complete Guide to Clinical Radiology ST3 Application and Recruitment (2027)

Recruitment paused: NHS England is not running Clinical Radiology ST3+ recru

Clinical Radiology ST3

Complete Guide to Paediatric Surgery ST3 Application and Recruitment in United Kingdom (2026)

Written by Medibuddy. Last updated: October 2026. If you’re planning

Paediatric Surgery ST3

Take your subscriptions with you

Our mobile app allows you to access your interview and exam question banks wherever you are.