‘The Bible’ of Complicated Pericarditis (Video)

What’s the biggest mistake in clinical practice for patients with complicated pericarditis? Changing medications too quickly — or what Cleveland Clinic cardiologist Allan Klein, MD, calls the “yo-yo effect.”

That’s just one of the clinical pearls shared by Dr. Klein in the short video below showcasing highlights of a state-of-the-art review of complicated pericarditis he published with Cleveland Clinic colleagues in Journal of the American College of Cardiology in late 2016.

The paper is a comprehensive, tour-de-force review of the subject focused on understanding risk factors and pathophysiology to inform multimodality imaging and treatment. The centerpiece is a highly useful central illustration outlining imaging and treatment considerations for each of five clinical stages of pericarditis in quick-reference tabular form.

Watch the video below for why Dr. Klein dubs the paper “the bible” of pericarditis, then check out the paper itself here. For a longer (20-minute) video of Dr. Klein reviewing key points from the paper (with slides), click here.

He divides the talk in the longer video into four sections: anatomy, stages, etiology and complications. He also discusses how multimodal imaging plays a major role in pericarditis, newer mechanisms of disease in recurrent pericarditis, and established and novel treatments. Regarding delayed enhancement, Dr. Klein states, “We did a study several years ago… where we asked the question, ‘If you have delayed enhancement… what would be the pathology?’ So we sent patients that had a pericardiectomy… we send that sample to the pathologist, and we found that basically when you have delayed enhancement… you really grow new blood vessels, you get neovascularization. When you give the dye, it seeps into the pericardial space, and as you get more organized pericarditis or organized fibrous pericarditis, you don’t get any delayed enhancement.”

Watch the longer video for more clinical pearls from this important review.