10th May 2025

Epidemiology

There are several pathologies that fall under the umbrella of pericardial disease, all of which are  interconnected, with one pericardial disease possibly resulting in another. The spectrum of clinical  presentation includes:  

1) Pericarditis/Acute pericarditis – inflammation of the pericardium. One of the most common  pericardial diseases and makes up around 5% of presentations with chest pain of non ischaemic  origin in the ED, as well as in 0.1% in all patients admitted to hospital. Acute pericarditis is a  sudden onset of pericarditis without the presence of effusion.  

2) Pericardial effusion – Excess of fluid in the pericardial space, which can be transudative,  exudative or sanguineous. Viral pericarditis being the leading cause of effusion forming, with  bacterial organisms such as Mycobacterium tuberculosum (TB) the most common cause in the  developing world.  

3) Cardiac tamponade – Fluid in the pericardial space leading to limited heart expansion and  venous return. An estimate from the United States places it at 2 in 10,000 per year, with 2%  of them being secondary to penetrating injuries to the chest.  

4) Constrictive pericarditis – long term inflammation of the pericardium causing thickening and  scarring. Rare in adults, and very rare in children, but increased risk if undergone cardiac  surgery.  

The aetiology of acute pericardial disease is varied and complex, however there are certain associated risk  factors:

• Infection – viral, bacterial including Mycoplasma tuberculosum  
• Malignancy  
• Post cardiac injury eg previous MI  
• Drugs and toxins  
• Radiation 
• Systemic illnesses/autoimmune disease
• End stage renal failure, uraemia 
• Penetrating injuries to the chest wall including trauma or surgery
• HIV/AIDS
• Male sex (in acute pericarditis)