Patient handout

Cardiac tamponade — effusive-constrictive pericarditis (Sagristà-Sauleda syndrome)

PRODUCTION

1. Your condition

This handout is for cardiac tamponade — effusive-constrictive pericarditis (sagristà-sauleda syndrome). Your care team identified this based on: echo: pericardial effusion with tamponade physiology plus septal bounce + restrictive mitral inflow + dilated non-collapsing ivc suggesting underlying constriction (klein jase 2013; sagristà-sauleda nejm 2004 pmid 15128896).

Other reasons your team may use this plan: beck triad → pericardiocentesis → jvd persists + ivc remains plethoric → effusive-constrictive physiology suspected; obtain post-drain hemodynamics; pericarditis with persistent crp elevation despite nsaid + colchicine + new pericardial effusion → inflammatory effusive-constrictive (esc 2015 §3.5); tb pericarditis on ripe — post-drainage constrictive physiology (most common etiology globally; mayosi heart 2017).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ibuprofen	600-800 mg PO TID × 1-2 wk then taper	PO	TID × 2 wk + taper	ICAP/CORP (Imazio NEJM 2013 PMID 23992557) — first-line for inflammatory pericarditis; eGFR + GI bleed risk gate use
aspirin	750-1000 mg PO TID × 1-2 wk then taper	PO	TID × 2 wk + taper	Preferred NSAID if post-MI Dressler etiology (does not impair ventricular remodeling like ibuprofen)
colchicine	0.6 mg PO BID (≥70 kg) or 0.6 mg daily (<70 kg) × 3 mo for first episode; × 6 mo for recurrent	PO	BID × 3-6 mo	ICAP (Imazio NEJM 2013 PMID 23992557) + CORP (Imazio Ann Intern Med 2011) + CORP-2 (Imazio Lancet 2014) — colchicine reduces recurrence + fibrosis; renal dose-adjust
prednisolone	0.2-0.5 mg/kg/day PO with slow taper over months	PO	daily, slow taper	ESC 2015 — reserve for NSAID-intolerant or autoimmune; LOW dose preferred (high-dose steroids associated with recurrence); IMPI Mayosi NEJM 2014 PMID 25199187 — adjunctive in HIV-NEGATIVE TB
methotrexate	10-15 mg PO weekly + folic acid	PO	weekly	ESC 2015 + small case series — corticosteroid-sparing for recurrent pericarditis
normal saline	500-1000 mL bolus	IV	rapid bolus then reassess	Bridge preload to drainage (ESC 2015)
norepinephrine	0.05-0.1 µg/kg/min titrate to MAP ≥65	IV	continuous	Bridge only — does not address obstruction (Roy JAMA 2007); persistent need post-drain raises suspicion for residual constriction
furosemide	20-40 mg PO daily titrate	PO	daily	Symptomatic relief while pericardiectomy evaluated; does NOT address constriction physiology (ESC 2015)

Plan: Effusive-constrictive pericarditis — pericardiocentesis + invasive hemodynamics + NSAID/colchicine + etiology-specific Rx + pericardiectomy decision (Sagristà-Sauleda NEJM 2004 PMID 15128896; ESC 2015; ICAP PMID 23992557)

3. When to call your provider

Contact your care team if any of the following happen:

Symptomatic chronic constrictive pericarditis (NYHA II-IV with constrictive physiology on imaging) despite 3-6 mo optimal medical therapy → cardiothoracic surgery for pericardiectomy (ESC 2015 Class IIa)
Radiation etiology — typically fibrotic + irreversible — earlier pericardiectomy referral
TB etiology — complete RIPE 4-6 mo before pericardiectomy decision unless decompensated
Recurrent effusion → re-drainage + diagnostic reconsideration
NSAID-related GI bleed → hold + reverse

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

After pericardiocentesis, RA pressure fails to fall ≥50% or to <10 mmHg despite normalisation of intrapericardial pressure → effusive-constrictive physiology confirmed (Sagristà-Sauleda NEJM 2004 PMID 15128896)
Radiation-induced effusive-constrictive pericarditis with persistent symptoms — radiation substrate is typically fibrotic and irreversible; pericardiectomy operative mortality is HIGHER in radiation field (mediastinal fibrosis, vascular adhesions); requires careful surgical evaluation by experienced pericardial surgery team
TB pericarditis presenting as effusive-constrictive — most common etiology globally per Mayosi Heart 2017; requires 4-drug RIPE × 6 mo + adjunctive prednisolone IF HIV-NEGATIVE per IMPI; pericardiectomy decision typically deferred until 4-6 mo of RIPE unless decompensated
Re-accumulation of pericardial effusion despite drainage + NSAID + colchicine + etiology-specific therapy — suggests treatment-resistant inflammation OR alternative etiology missed (occult malignancy, TB, autoimmune)
After pericardiocentesis evacuates fluid, hemodynamic decompensation occurs — residual visceral constriction limits diastolic filling; clinical correlate of effusive-constrictive physiology that requires bridging therapy + urgent cardiothoracic surgery evaluation(life-threatening)

5. Follow-up

Long-term cardiology + cardiothoracic surgery + etiology-specific specialist follow-up; pericardiectomy if symptomatic constriction persists at 6 mo despite optimal medical therapy (ESC 2015 Class IIa)

6. Sources

Guideline: Sagristà-Sauleda J et al. NEJM 2004 PMID 15128896 — diagnostic hemodynamic definition of effusive-constrictive pericarditis (sentinel paper); 2015 ESC Pericardial Diseases (Adler EHJ 2015 PMID 26320112) §3.5 anchors management pathway including pericardiectomy decision criteria; ICAP (Imazio NEJM 2013 PMID 23992557) anchors NSAID + colchicine for inflammatory etiology; IMPI (Mayosi NEJM 2014 PMID 25199187) anchors steroid decision in TB etiology by HIV status; WHO TB 2024 anchors RIPE 4-drug regimen if TB etiology; Klein JASE 2013 anchors multimodality pericardial imaging; Murashita JTCVS Mayo experience anchors pericardiectomy operative outcomes.