Contemporary Reviews in Cardiovascular Medicine Controversial Issues in the Management of Pericardial Diseases

The management of pericardial diseases is largely empir-ical 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 Ameri-can College of Cardiology. After a literature review including a Medline search with the MeSH terms “pericarditis ” and “pericardium, ” we identified the following controversial is-sues related mainly to the management of pericarditis and pericardial effusion: (1) etiological search and hospitaliza-tion; (2) role of pericardiocentesis, pericardial biopsy, and pericardioscopy; (3) myopericarditis; (4) use of corticoste-roids, 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 o