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This mini-symposium is devoted to the so-called “cinderella of heart disease”—pericardial disease. The management of thise disease, contrary to most cardiac diseases, has scarcely been influenced by recent advances in technology. In many cases the aetiology of pericardial disease is apparently due to the presence of a concomitant disease; however, in patients without an apparent cause the aetiology remains elusive, being idiopathic (in most cases probably being viral in origin) in more than 90% of cases. Our point of view is that “old” clinical management (history, physical examination, and routine laboratory tests), with a judicious indication of invasive procedures, is the appropriate approach for most patients.
Gaietà Permanyer-Miralda, from Barcelona, comments on the general approach to acute pericardial disease. His point of view is based on a large experience of systematic management of acute pericardial disease for the last 25 years, at the same institution. He also discusses the impact of recent devices (for example, the pericardioscope) or the impact of new diseases (for example, AIDS). Ralph Shabetai, from La Jolla, California, covers the wide spectrum of pericardial effusion, with special emphasis on atypical forms of cardiac tamponade that can only be clinically identified with a high clinical suspicion index. For centuries, cardiac constriction was supposed to be a rather permanent, uniform pattern of pericardial involvement. Jaume Sagristà-Sauleda, from Barcelona, challenges this concept and discusses new patterns of cardiac constriction, from transient to occult constriction.
These presentations aim to provide information which is directly related to the clinical management of patients with pericardial disease. I hope that some of the thoughts from the outstanding contributors of this mini-symposium will help physicians improve their treatment of the “cinderella of heart disease” in the future.