Pericardial Disease
Basic Information 
Clinical Presentation
Physical Exam Findings
• If cardiac tamponade is present, common physical examination abnormalities include those consistent with right-sided heart failure (tachycardia, jugular and other peripheral venous distension, ventral edema), poor pulses or pulsus paradoxus, variably abnormal mucous membranes (pale, injected, cyanotic), and muffled heart sounds.
• A gallop rhythm might be heard in cases of constrictive pericarditis.
• Pericardial friction rubs can be heard in cases of fibrinous pericarditis.
• Nonspecific signs in cases that may not have cardiac tamponade include fever, lethargy, tachypnea or dyspnea, and quiet lung sounds ventrally.
Etiology and Pathophysiology
• Inflammation of the pericardium may be caused by infectious agents, spread of contiguous disease from the lungs or pleura, congestive heart failure, sepsis, immune-mediated disease, trauma, or neoplasia.
• This leads to fluid accumulation within the pericardial space (effusive pericarditis) or fibrosis of the pericardial membranes (constrictive pericarditis).
• Restriction to cardiac filling occurs, which predominantly affects the right heart.
• Right-sided congestive heart failure and forward failure may occur; the latter also leads to left-sided forward failure (see “Cardiac Failure” in this section).
Diagnosis 
Differential Diagnosis
• Right-sided heart failure: Primary myocardial, valvular, or congenital heart disease; cranial mediastinal mass
• Respiratory signs: Pulmonary or pleural disease
• Tachycardia: Primary arrhythmia such as ventricular tachycardia or supraventricular tachycardia
• Fever, anorexia, depression, weight loss: Other systemic illnesses
Initial Database
• Complete blood count: Changes consistent with infection or inflammation or with a stress leukogram (leukocytosis, neutrophilia, lymphopenia, anemia of chronic disease, hyperfibrinogenemia)
• Chemistry panel: Changes consistent with third spacing of fluids (hypoalbuminemia, hyponatremia), congestion from right-sided heart failure (increased liver enzymes), or organ dysfunction caused by decreased cardiac output (azotemia)
• Electrocardiography (ECG): Sinus tachycardia (compensatory) and low-amplitude QRS complexes. Electrical alternans can be seen (Figure 1), although the sensitivity of this diagnostic test is low.
• Thoracic radiography: Not sensitive for a specific diagnosis of pericarditis but can show an enlarged cardiac silhouette with effusive pericarditis. Useful to assess pulmonary involvement and concurrent pneumonia or pleuropneumonia.
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