Guidelines of the Spanish Society of Cardiology on pericardial disease

The pericardium is a serous membrane consisting of two layers (parietal and visceral), which may be involved by different infectious, physical, trauma tic, or inflammatory agents as well as in metabolic or systemic diseases. T he reactions of the pericardium to these insults result in rather nonspecif ic clinical features, such as the characteristic inflammatory findings in a cute pericarditis, the development of pericardial effusion with the possibl e complication of cardiac tamponade, and a fibrous retractile reaction that may lead to constrictive pericarditis. These phenomena are not mutually ex clusive and can be simultaneous or consecutive in the same patient; however , for the sake of clarity they are independently discussed. The aim or the present guidelines is to provide orientation about the manag ement of patients with pericardial disease. Such management should basicall y rest on the knowledge of the clinical and epidemiological features (such as disease frequency) of the different types of pericardial disease that de termine the diagnostic and therapeutic yield of the different invasive peri cardial procedures (pericardiocentesis, pericardial biopsy and pericardiect omy), and, therefore, their respective indications. In addition, the indica tion of the different types of medical therapy are discussed. On the other hand, emphasis is made on the possible limitation of the validity of these guidelines for patients belonging to geographical areas or socioeconomic co ntexts with different etiologic spectra.