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cardio.cardiac-tamponade.radiation-late-effusive-constrictive.v1

Cardiac tamponade — late post-radiation effusive-constrictive pericarditis

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Late post-radiation effusive-constrictive pericarditis — combined effusion + visceral pericardial fibrotic constriction 5-20+ years after mediastinal radiation; pericardiocentesis fails to relieve elevated atrial pressures (pathognomonic); pericardiectomy preferred for symptomatic disease (high-risk in radiation tissue) (ESC 2015 §Effusive-Constrictive + §Radiation-Induced; Sagristà-Sauleda NEJM 2004 PMID 14749453)

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late radiation effusive-constrictive context confirmed

Patient inputs (11)

Late effusive-constrictive presents 5-20+ years post-radiation; median patient age 50-70 at presentation per Aleman JCO 2003 PMID 12586791

Mediastinal radiation specifics: dose (>30 Gy mantle for Hodgkin or mean heart dose >5 Gy per Darby NEJM 2013 PMID 23484825), field, latency 5-20+ years from completion; cancer type and current oncologic status

Sinus tachycardia compensatory; AF common in long-term radiation survivors (Lyon EHJ 2022)

Renal function for diuretic + drug dosing + contrast-enhanced CMR/CT decisions; KDIGO 2026 race-free eGFR (Inker NEJM 2021)

Active vs remission cancer drives differential (radiation late effect vs metastatic recurrence) and goals of care for high-risk pericardiectomy (Lyon EHJ 2022)

Markedly elevated JVP with Kussmaul sign (paradoxical inspiratory rise) is hallmark; persists after pericardiocentesis if effusive-constrictive (Sagristà-Sauleda NEJM 2004)

TTE with septal bounce + tissue Doppler annulus reversus + respiratory variation in mitral inflow (>25%) + dilated non-collapsing IVC + tethering — distinguishes constrictive from restrictive (Talreja Circulation 2003; ESC 2015 Class I)

Cardiac MRI — pericardial thickening >4 mm, late gadolinium enhancement, tethering, real-time cine for septal bounce; gold standard differentiating constrictive vs restrictive (Lyon EHJ 2022; ESC 2015)

Discordantly low/normal BNP relative to clinical congestion supports constrictive over restrictive/HF; BNP <100 with NYHA III-IV congestion is classic (ESC 2015)

BP often preserved in chronic effusive-constrictive (low-output but compensated); pulsus paradoxus may be present from effusion component (ESC 2015)

CT for pericardial calcification (highly specific for late radiation pericarditis) + thickness measurement + co-existing radiation lung/mediastinal pathology (Lyon EHJ 2022; Heidenreich JACC 2010)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (5)

5 need judgement
  • informationalseverepersistent_elevated_atrial_pressure_after_pericardiocentesis_pathognomonic
    Persistent elevated right atrial pressure / JVP after apparently successful pericardiocentesis in late radiation survivor — PATHOGNOMONIC for effusive-constrictive pericarditis; pericardiectomy required for definitive treatment (Sagristà-Sauleda NEJM 2004 PMID 14749453; ESC 2015 §Effusive-Constrictive)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereprogressive_constrictive_decompensation_with_cardiac_cirrhosis_in_radiation_survivor
    Progressive constrictive decompensation with cardiac cirrhosis (elevated LFTs, ascites, hyperbilirubinemia, hypoalbuminemia) in late radiation survivor — pericardiectomy mandatory for survival; high-risk in radiation tissue (ESC 2015; Bertog EHJ 2004 PMID 15010459)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverepericardiectomy_decision_in_radiation_field_high_operative_risk
    Surgical decision-making for pericardiectomy in radiation-damaged tissue with effusive-constrictive physiology — multidisciplinary balance of refractory symptoms vs operative mortality 10-20% with radical pericardiectomy preferred (Bertog EHJ 2004 PMID 15010459; Welch Mayo Clin Proc 2008; Murashita Ann Thorac Surg 2017)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverecancer_recurrence_vs_radiation_late_effect_attribution_in_late_survivor
    Cancer recurrence vs radiation late effect attribution challenge in patient with prior chest radiation 5-20+ years ago presenting with effusive-constrictive pattern — comprehensive workup mandatory before high-risk surgery (Lyon EHJ 2022)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatedifferentiating_constrictive_from_restrictive_cardiomyopathy_in_radiation_survivor
    Diagnostic challenge: late radiation effusive-constrictive pericarditis vs radiation-induced restrictive cardiomyopathy (myocardial fibrosis without pericardial thickening) — distinct treatments (pericardiectomy vs medical HF management) (Talreja Circulation 2003; ESC 2015 §Constrictive)
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Late post-radiation effusive-constrictive pericarditis — diuretic bridge + anti-inflammatory for active inflammation + pericardiectomy as definitive (ESC 2015 §Effusive-Constrictive + §Radiation-Induced; Lyon EHJ 2022 PMID 35993161; Bertog EHJ 2004 PMID 15010459)
axis: late_radiation_effusive_constrictive_diuretic_bridge_to_pericardiectomy
Selected axis "Late post-radiation effusive-constrictive pericarditis — diuretic bridge + anti-inflammatory for active inflammation + pericardiectomy as definitive (ESC 2015 §Effusive-Constrictive + §Radiation-Induced; Lyon EHJ 2022 PMID 35993161; Bertog EHJ 2004 PMID 15010459)" by default fallback (first axis)
  • furosemide
    first line
    loop_diuretic
    40-80 mg IV/PO daily; titrate to 1-2 kg/d weight loss until euvolemic • IV/PO • daily-BID
    triggers: volume_overload_in_effusive_constrictive_pre_pericardiectomy
    ESC 2015 + Lyon EHJ 2022 — first-line for volume management bridge to pericardiectomy; titrate aggressively to euvolemia to optimize surgical candidacy
    rxcui 4603
  • spironolactone
    add on
    mineralocorticoid_receptor_antagonist
    25-50 mg PO daily • PO • daily
    triggers: refractory_volume_overload_with_loop_diuretic_alone, cardiac_cirrhosis_ascites
    Synergistic diuresis with loop; aldosterone-mediated retention common in chronic congestive states; helpful for cardiac cirrhosis ascites (ESC 2015)
    rxcui 9997
  • metolazone
    add on
    thiazide_like_diuretic
    2.5-5 mg PO daily 30 min before loop • PO • daily
    triggers: diuretic_resistance_with_loop_alone
    Sequential nephron blockade for refractory volume overload bridge to surgery (ESC 2015)
    rxcui 6916
  • ibuprofen
    second line
    nsaid_propionic_acid
    600 mg PO TID × 2 wk if active inflammation on CMR (LGE + edema) • PO • TID
    triggers: active_inflammatory_component_on_cmr_with_normal_renal_function
    ESC 2015 + ICAP PMID 23992557 — anti-inflammatory if CMR shows active inflammation; AVOID if eGFR <30 or pre-renal AKI from low-output state
    rxcui 5640
  • colchicine
    add on
    antimitotic
    0.5 mg BID (0.5 mg daily if <70 kg or eGFR 30-60) × 3 mo • PO • BID
    triggers: active_inflammatory_component_on_cmr_or_recurrent_pericarditis_pattern
    ICAP (Imazio NEJM 2013 PMID 23992557) + CORP (Imazio Ann Intern Med 2011 PMID 21788540) — RR 0.62 for recurrence; helpful for inflammatory component
    rxcui 2683
  • rilonacept
    rescue
    il1_trap
    320 mg SC loading then 160 mg SC weekly maintenance • SC • weekly
    triggers: recurrent_inflammatory_component_failing_nsaid_colchicine
    RHAPSODY (Klein NEJM 2021 PMID 33999548) — IL-1 trap for refractory recurrent pericarditis; particularly useful in radiation survivors where corticosteroids contraindicated
    rxcui 763450
  • acetaminophen
    first line
    analgesic
    650-1000 mg q6h scheduled • PO • q6h
    triggers: pericarditic_pain_when_nsaid_contraindicated
    Alternative analgesic when NSAIDs contraindicated (renal impairment, anticoagulation)
    rxcui 161
  • warfarin
    comorbidity specific
    vitamin_k_antagonist
    2.5-5 mg PO daily INR target 2-3 • PO • daily
    triggers: atrial_fibrillation_in_radiation_survivor_cha2ds2vasc_ge_2
    AF common in long-term radiation survivors due to atrial fibrosis; CHA2DS2-VASc guides anticoagulation; warfarin preferred over DOAC peri-pericardiectomy for reversibility
    rxcui 11289
  • norepinephrine
    rescue
    vasopressor
    0.05-0.1 µg/kg/min titrate MAP ≥65 • IV • continuous
    triggers: MAP_lt_65_in_acute_decompensation_of_effusive_constrictive
    Bridge for decompensated effusive-constrictive with hypotension while expediting pericardiectomy; does not address obstruction (Roy JAMA 2007)
    rxcui 7512
  • albumin
    add on
    colloid_oncotic_support
    25 g IV q12h • IV • q12h
    triggers: hypoalbuminemia_with_anasarca_in_cardiac_cirrhosis
    Adjunct for diuretic-resistant volume overload with hypoalbuminemia from cardiac cirrhosis; modest evidence
    rxcui 828529

outpatient playbook — drug actions (5)

  1. 1. as-needed treatment for recurrent inflammatory pericarditis
    rxcui 5640
    ibuprofen 600 mg TID + colchicine 0.5 mg BID for 3 mo for recurrence • PO • TID + BID
    trigger: Recurrent pericarditis episode
    CORP (Imazio Ann Intern Med 2011 PMID 21788540) + ICAP
  2. 2. rilonacept for recurrent refractory
    rxcui 966571
    160 mg SC weekly maintenance after 320 mg load • SC • weekly
    trigger: Multiple recurrences failing NSAID + colchicine
    RHAPSODY PMID 33999548 — preferred over corticosteroids in radiation patients
  3. 3. CV risk modification per radiation-induced CAD risk
    rxcui 83367
    atorvastatin 40-80 mg daily if LDL elevated or radiation-induced CAD • PO • daily
    trigger: Elevated CV risk in radiation survivor
    AHA 2022 cardio-oncology + 2025 ACC/AHA Lipid guideline
  4. 4. continued anticoagulation for AF
    rxcui 11289
    warfarin INR 2-3 or DOAC per CHA2DS2-VASc • PO • daily
    trigger: Persistent AF in radiation survivor
    AHA/ACC/HRS 2023 AF guideline (Joglar JACC 2024)
  5. 5. maintenance diuretic if persistent congestion post-op
    rxcui 4603
    furosemide 20-40 mg PO daily titrate • PO • daily
    trigger: Residual congestion post-pericardiectomy
    ESC 2015 — many patients require ongoing diuretic post-op

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Cancer survivor (Hodgkin lymphoma mantle field, left-sided breast, lung, esophageal) 5-20+ years post-mediastinal radiation presenting with insidious progressive dyspnea + peripheral edema + ascites + fatigue (ESC 2015 §Effusive-Constrictive + §Radiation-Induced; Lyon EHJ 2022 PMID 35993161); Echo with pericardial effusion + septal bounce + tissue Doppler annulus reversus + dilated IVC + Kussmaul respiratory variation in radiation survivor (Talreja Circulation 2003; ESC 2015); Cardiac MRI showing pericardial thickening >4 mm + late gadolinium enhancement + tethering of pericardium to myocardium in patient 5+ years post-radiation (Lyon EHJ 2022; Heidenreich JACC 2010).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Cardiac tamponade — late post-radiation effusive-constrictive pericarditis** (cardio.cardiac-tamponade.radiation-late-effusive-constrictive.v1).
Phenotype framing: Differentiate: radiation-induced effusive-constrictive (this engine — LGE + thickening + calcification + cancer hx) vs radiation-induced restrictive cardiomyopathy (myocardial fibrosis without pericardial thickening) vs primary HFpEF (no pericardial pathology) vs radiation valvular disease vs metastatic recurrence (cytology + tumor markers + PET-CT) vs constrictive pericarditis from other etiology — RH cath with simultaneous LV/RV pressures (square root sign + ventricular interdependence + dip-and-plateau) is gold standard (ESC 2015 Class I; Talreja 2003)
Scope: Late post-radiation effusive-constrictive pericarditis — combined effusion + visceral pericardial fibrotic constriction 5-20+ years after mediastinal radiation; pericardiocentesis fails to relieve elevated atrial pressures (pathognomonic); pericardiectomy preferred for symptomatic disease (high-risk in radiation tissue) (ESC 2015 §Effusive-Constrictive + §Radiation-Induced; Sagristà-Sauleda NEJM 2004 PMID 14749453)

No severity triggers fired against current inputs.

Plan

Regimen axis: **Late post-radiation effusive-constrictive pericarditis — diuretic bridge + anti-inflammatory for active inflammation + pericardiectomy as definitive (ESC 2015 §Effusive-Constrictive + §Radiation-Induced; Lyon EHJ 2022 PMID 35993161; Bertog EHJ 2004 PMID 15010459)**.
1. furosemide 40-80 mg IV/PO daily; titrate to 1-2 kg/d weight loss until euvolemic IV/PO daily-BID (loop_diuretic, first line) — ESC 2015 + Lyon EHJ 2022 — first-line for volume management bridge to pericardiectomy; titrate aggressively to euvolemia to optimize surgical candidacy
2. spironolactone 25-50 mg PO daily PO daily (mineralocorticoid_receptor_antagonist, add on) — Synergistic diuresis with loop; aldosterone-mediated retention common in chronic congestive states; helpful for cardiac cirrhosis ascites (ESC 2015)
3. metolazone 2.5-5 mg PO daily 30 min before loop PO daily (thiazide_like_diuretic, add on) — Sequential nephron blockade for refractory volume overload bridge to surgery (ESC 2015)
4. ibuprofen 600 mg PO TID × 2 wk if active inflammation on CMR (LGE + edema) PO TID (nsaid_propionic_acid, second line) — ESC 2015 + ICAP PMID 23992557 — anti-inflammatory if CMR shows active inflammation; AVOID if eGFR <30 or pre-renal AKI from low-output state
5. colchicine 0.5 mg BID (0.5 mg daily if <70 kg or eGFR 30-60) × 3 mo PO BID (antimitotic, add on) — ICAP (Imazio NEJM 2013 PMID 23992557) + CORP (Imazio Ann Intern Med 2011 PMID 21788540) — RR 0.62 for recurrence; helpful for inflammatory component
6. rilonacept 320 mg SC loading then 160 mg SC weekly maintenance SC weekly (il1_trap, rescue) — RHAPSODY (Klein NEJM 2021 PMID 33999548) — IL-1 trap for refractory recurrent pericarditis; particularly useful in radiation survivors where corticosteroids contraindicated
7. acetaminophen 650-1000 mg q6h scheduled PO q6h (analgesic, first line) — Alternative analgesic when NSAIDs contraindicated (renal impairment, anticoagulation)
8. warfarin 2.5-5 mg PO daily INR target 2-3 PO daily (vitamin_k_antagonist, comorbidity specific) — AF common in long-term radiation survivors due to atrial fibrosis; CHA2DS2-VASc guides anticoagulation; warfarin preferred over DOAC peri-pericardiectomy for reversibility
9. norepinephrine 0.05-0.1 µg/kg/min titrate MAP ≥65 IV continuous (vasopressor, rescue) — Bridge for decompensated effusive-constrictive with hypotension while expediting pericardiectomy; does not address obstruction (Roy JAMA 2007)
10. albumin 25 g IV q12h IV q12h (colloid_oncotic_support, add on) — Adjunct for diuretic-resistant volume overload with hypoalbuminemia from cardiac cirrhosis; modest evidence

Setting playbook (outpatient) — Long-term cancer survivorship cardiac surveillance (annual echo + symptom assessment + comprehensive cardiac MRI q3-5 yr in high-risk cohorts); recurrence prevention; pericardiectomy follow-up if performed; CV risk modification for radiation-induced CAD (Lyon EHJ 2022 PMID 35993161; Heidenreich JACC 2010 PMID 19789419)
11. as-needed treatment for recurrent inflammatory pericarditis ibuprofen 600 mg TID + colchicine 0.5 mg BID for 3 mo for recurrence PO TID + BID — Recurrent pericarditis episode (CORP (Imazio Ann Intern Med 2011 PMID 21788540) + ICAP)
12. rilonacept for recurrent refractory 160 mg SC weekly maintenance after 320 mg load SC weekly — Multiple recurrences failing NSAID + colchicine (RHAPSODY PMID 33999548 — preferred over corticosteroids in radiation patients)
13. CV risk modification per radiation-induced CAD risk atorvastatin 40-80 mg daily if LDL elevated or radiation-induced CAD PO daily — Elevated CV risk in radiation survivor (AHA 2022 cardio-oncology + 2025 ACC/AHA Lipid guideline)
14. continued anticoagulation for AF warfarin INR 2-3 or DOAC per CHA2DS2-VASc PO daily — Persistent AF in radiation survivor (AHA/ACC/HRS 2023 AF guideline (Joglar JACC 2024))
15. maintenance diuretic if persistent congestion post-op furosemide 20-40 mg PO daily titrate PO daily — Residual congestion post-pericardiectomy (ESC 2015 — many patients require ongoing diuretic post-op)

Non-pharmacologic actions:
- Cardiology annual or biennial follow-up
- Oncology surveillance per cancer protocol
- Cardiothoracic surgery follow-up post-pericardiectomy at 1, 3, 6, 12 mo then annually × 5 yr
- Cardiac rehabilitation if appropriate post-pericardiectomy
- Smoking cessation, BP control, lipid management for compounded CV risk per AHA 2025
- Vaccination updates (pneumococcal, influenza, COVID-19)

AVOID / contraindication checks:
- Positive_pressure_ventilation_AVOID_pre_drain_in_acute_tamponade_component (ESC 2015)
- Nsaid_AVOID_eGFR_lt_30_or_pre_renal_aki_from_low_output_or_active_GI_bleed (ESC 2015)
- Corticosteroids_AVOID_in_radiation_tissue_impairs_wound_healing_pre_pericardiectomy (ESC 2015 §Radiation Induced; Bertog EHJ 2004)
- Colchicine_dose_reduce_renal_impairment_eGFR_30_60_AVOID_eGFR_lt_30 (drug label)
- Colchicine_AVOID_concurrent_strong_cyp3a4_clarithromycin_pgp_inhibitor (drug label)
- Pericardiectomy_high_operative_mortality_10_20_percent_in_radiation_damaged_tissue_high_volume_center_required (Bertog EHJ 2004 PMID 15010459)
- Gadolinium_avoid_linear_agents_eGFR_lt_30_use_group_II_III_macrocyclic (ACR 2024 contrast manual)
- DOAC_caution_pre_pericardiectomy_use_warfarin_for_reversibility (ESC 2015)
- Expect_persistent_elevated_atrial_pressures_after_pericardiocentesis_pathognomonic_for_effusive_constrictive_NOT_failed_drainage (Sagristà Sauleda NEJM 2004 PMID 14749453)

Monitoring

Regimen monitoring:
- daily weight BMP creatinine during diuretic titration (ESC 2015)
- echo pre and post pericardiocentesis to document persistent constrictive physiology (Sagristà-Sauleda 2004)
- CMR for pericardial thickening LGE pre pericardiectomy planning (Lyon EHJ 2022)
- right heart catheterization simultaneous LV RV pressures square root sign ventricular interdependence (ESC 2015 Class I)
- long term cardiac surveillance in radiation survivors annual echo per lyon 2022 (Lyon EHJ 2022 PMID 35993161)
- comprehensive cardiac MRI q3 5yr in high risk cohorts mantle radiation mean heart dose gt 15 gy (Lyon 2022)
- CRP + ESR to track inflammatory response if inflammatory component (ESC 2015)
- symptom assessment dyspnea edema ascites NYHA class at each visit
- oncology co management with cardiology and cardiothoracic surgery (Lyon 2022)
- INR weekly during warfarin initiation then monthly for AF (AHA/ACC/HRS 2023 AF)

Setting (outpatient) monitoring:
- Annual echo
- Cardiac MRI q3-5 yr in high-risk cohorts (Lyon 2022)
- Annual lipid + HbA1c + BP
- ECG annually
- INR per AC clinic schedule if anticoagulated

Monitoring phase: Diuretic response (weight, BMP daily); echo at 24-48h post-pericardiocentesis to confirm persistent constrictive physiology; CMR pre-op for surgical planning; long-term cancer-survivorship cardiac surveillance per Lyon 2022 (annual echo + CMR q3-5 yr in high-risk cohorts: mantle radiation, mean heart dose >15 Gy)

Disposition

Current setting: outpatient — Long-term cancer survivorship cardiac surveillance (annual echo + symptom assessment + comprehensive cardiac MRI q3-5 yr in high-risk cohorts); recurrence prevention; pericardiectomy follow-up if performed; CV risk modification for radiation-induced CAD (Lyon EHJ 2022 PMID 35993161; Heidenreich JACC 2010 PMID 19789419)

Disposition criteria:
- Stable + survivorship surveillance ongoing + no acute decompensation → routine annual cardiology follow-up

Escalation triggers (move to higher acuity):
- Recurrent inflammatory pericarditis → NSAID + colchicine + escalate to rilonacept if failing
- Constrictive deterioration → cardiothoracic surgery for re-evaluation (rare post-radical pericardiectomy)
- New cancer recurrence → multidisciplinary reassessment
- Late radiation cardiotoxicity (CAD, valvular disease, restrictive CMP) → cardiology workup
- Tamponade recurrence → re-route to acute pathway
- AF onset → CHA2DS2-VASc + AC initiation per AHA/ACC/HRS 2023

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [SEVERE] Persistent elevated right atrial pressure / JVP after apparently successful pericardiocentesis in late radiation survivor — PATHOGNOMONIC for effusive-constrictive pericarditis; pericardiectomy required for definitive treatment (Sagristà-Sauleda NEJM 2004 PMID 14749453; ESC 2015 §Effusive-Constrictive)
- [SEVERE] Progressive constrictive decompensation with cardiac cirrhosis (elevated LFTs, ascites, hyperbilirubinemia, hypoalbuminemia) in late radiation survivor — pericardiectomy mandatory for survival; high-risk in radiation tissue (ESC 2015; Bertog EHJ 2004 PMID 15010459)
- [SEVERE] Surgical decision-making for pericardiectomy in radiation-damaged tissue with effusive-constrictive physiology — multidisciplinary balance of refractory symptoms vs operative mortality 10-20% with radical pericardiectomy preferred (Bertog EHJ 2004 PMID 15010459; Welch Mayo Clin Proc 2008; Murashita Ann Thorac Surg 2017)

Citations

- 2015 ESC Guidelines for the diagnosis and management of pericardial diseases (Adler EHJ 2015 PMID 26320112) §Effusive-Constrictive + §Radiation-Induced Pericarditis remain current as of 2026-05-15; 2022 ESC Cardio-oncology Guideline (Lyon EHJ 2022 PMID 35993161) anchors cancer survivorship surveillance + pericardial disease management; Sagristà-Sauleda NEJM 2004 PMID 14749453 is the original effusive-constrictive description; Bertog EHJ 2004 PMID 15010459 anchors pericardiectomy outcomes in radiation; Welch Mayo Clin Proc 2008 + Murashita Ann Thorac Surg 2017 anchor long-term surgical outcomes; Hancock JAMA 1993 PMID 8455714 + Aleman JCO 2003 PMID 12586791 + Heidenreich JACC 2010 PMID 19789419 + Darby NEJM 2013 PMID 23484825 anchor radiation cardiotoxicity epidemiology; ICAP (Imazio NEJM 2013 PMID 23992557) + RHAPSODY (Klein NEJM 2021 PMID 33999548) anchor anti-inflammatory therapy. [PMID:26320112](https://pubmed.ncbi.nlm.nih.gov/26320112/)
- Cited evidence (PMID 35993161) [PMID:35993161](https://pubmed.ncbi.nlm.nih.gov/35993161/)
- Cited evidence (PMID 14749453) [PMID:14749453](https://pubmed.ncbi.nlm.nih.gov/14749453/)
- Cited evidence (PMID 15010459) [PMID:15010459](https://pubmed.ncbi.nlm.nih.gov/15010459/)
- Cited evidence (PMID 8455714) [PMID:8455714](https://pubmed.ncbi.nlm.nih.gov/8455714/)

Last reconciled with current guidelines: 2026-05-15.
References
  • 2015 ESC Guidelines for the diagnosis and management of pericardial diseases (Adler EHJ 2015 PMID 26320112) §Effusive-Constrictive + §Radiation-Induced Pericarditis remain current as of 2026-05-15; 2022 ESC Cardio-oncology Guideline (Lyon EHJ 2022 PMID 35993161) anchors cancer survivorship surveillance + pericardial disease management; Sagristà-Sauleda NEJM 2004 PMID 14749453 is the original effusive-constrictive description; Bertog EHJ 2004 PMID 15010459 anchors pericardiectomy outcomes in radiation; Welch Mayo Clin Proc 2008 + Murashita Ann Thorac Surg 2017 anchor long-term surgical outcomes; Hancock JAMA 1993 PMID 8455714 + Aleman JCO 2003 PMID 12586791 + Heidenreich JACC 2010 PMID 19789419 + Darby NEJM 2013 PMID 23484825 anchor radiation cardiotoxicity epidemiology; ICAP (Imazio NEJM 2013 PMID 23992557) + RHAPSODY (Klein NEJM 2021 PMID 33999548) anchor anti-inflammatory therapy. — PMID:26320112
  • Cited evidence (PMID 35993161) — PMID:35993161
  • Cited evidence (PMID 14749453) — PMID:14749453
  • Cited evidence (PMID 15010459) — PMID:15010459
  • Cited evidence (PMID 8455714) — PMID:8455714