Sections

Pericardial Effusion

Presentation

History

Cardiovascular symptoms in pericardial effusion can include the following:

Chest pain, pressure, discomfort - Characteristically, pericardial pain may be relieved by sitting up and leaning forward and is intensified by lying supine.
Light-headedness, syncope
Palpitations

Respiratory symptoms can include the following:

Cough
Dyspnea
Hoarseness

Neurologic symptoms of pericardial effusion can include anxiety and confusion, while hiccoughs may occur as a gastrointestinal (GI) symptom.

Physical Examination

Cardiovascular findings in pericardial effusion can include the following:

Classic Beck triad of pericardial tamponade - Hypotension, muffled heart sounds, jugular venous distention
Pulsus paradoxus - Exaggeration of physiologic respiratory variation in systemic blood pressure, defined as a decrease in systolic blood pressure of more than 10mm Hg with inspiration, signaling falling cardiac output during inspiration
Pericardial friction rub
Tachycardia
Hepatojugular reflux - This can be observed by applying pressure to the periumbilical region; a rise in the jugular venous pressure (JVP) of greater than 3 cm H₂ O for more than 30 seconds suggests elevated central venous pressure (however, transient elevation in JVP may be normal)

Pericardial friction rub, the most important physical sign of acute pericarditis, may have up to 3 components per cardiac cycle and is high-pitched, scratching, and grating. It can sometimes be elicited only when firm pressure with the diaphragm of the stethoscope is applied to the chest wall at the left lower sternal border. The pericardial friction rub is heard most frequently during expiration with the patient upright and leaning forward.

Respiratory findings can include the following:

Tachypnea
Decreased breath sounds - Secondary to pleural effusions^[10]
Ewart sign - Dullness to percussion beneath the angle of left scapula from compression of the left lung by pericardial fluid

Hepatosplenomegaly represents a GI symptom of pericardial effusion. Findings in the patient’s extremities can include weakened peripheral pulses, edema, and cyanosis.

Differential Diagnoses

Montaudon M, Roubertie F, Bire F, Laurent F. Congenital pericardial defect: report of two cases and literature review. Surg Radiol Anat. 2007 Apr. 29(3):195-200. [QxMD MEDLINE Link].
Kuvin JT, Harati NA, Pandian NG, Bojar RM, Khabbaz KR. Postoperative cardiac tamponade in the modern surgical era. Ann Thorac Surg. 2002 Oct. 74(4):1148-53. [QxMD MEDLINE Link].
Tsang TS, Barnes ME, Hayes SN, et al. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998. Chest. 1999 Aug. 116(2):322-31. [QxMD MEDLINE Link].
Ciliberto GR, Anjos MC, Gronda E, et al. Significance of pericardial effusion after heart transplantation. Am J Cardiol. 1995 Aug 1. 76(4):297-300. [QxMD MEDLINE Link].
Rosenbaum E, Krebs E, Cohen M, et al. The spectrum of clinical manifestations, outcome and treatment of pericardial tamponade in patients with systemic lupus erythematosus: a retrospective study and literature review. Lupus. 2009 Jun. 18(7):608-12. [QxMD MEDLINE Link].
Biteker FS, Biteker M, Basaran O, et al. A small pericardial effusion is a marker of complicated hospitalization in patients with community-acquired pneumonia. J Crit Care. 2017 Nov 23. 44:294-9. [QxMD MEDLINE Link].
Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. 2007 Jan. 60(1):27-34. [QxMD MEDLINE Link].
Meenakshisundaram R, Sweni S, Thirumalaikolundusubramanian P. Cardiac isoform of alpha 2 macroglobulin: a marker of cardiac involvement in pediatric HIV and AIDS. Pediatr Cardiol. 2010 Feb. 31(2):203-7. [QxMD MEDLINE Link].
Lind A, Reinsch N, Neuhaus K, et al. Pericardial effusion of HIV-infected patients? Results of a prospective multicenter cohort study in the era of antiretroviral therapy. Eur J Med Res. 2011 Nov 10. 16(11):480-3. [QxMD MEDLINE Link]. [Full Text].
Natanzon A, Kronzon I. Pericardial and pleural effusions in congestive heart failure-anatomical, pathophysiologic, and clinical considerations. Am J Med Sci. 2009 Sep. 338(3):211-6. [QxMD MEDLINE Link].
Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet. 2004 Feb 28. 363(9410):717-27. [QxMD MEDLINE Link].
Imazio M, Brucato A, Cumetti D, et al. Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation. Circulation. 2008 Aug 5. 118(6):667-71. [QxMD MEDLINE Link].
Leonardi A, Penta L, Cofini M, Lanciotti L, Principi N, Esposito S. Pericardial effusion as a presenting symptom of Hashimoto thyroiditis: a case report. Int J Environ Res Public Health. 2017 Dec 14. 14(12):[QxMD MEDLINE Link].
Permanyer-Miralda G, Sagrista-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol. 1985 Oct 1. 56(10):623-30. [QxMD MEDLINE Link].
Ben-Horin S, Bank I, Shinfeld A, Kachel E, Guetta V, Livneh A. Diagnostic value of the biochemical composition of pericardial effusions in patients undergoing pericardiocentesis. Am J Cardiol. 2007 May 1. 99(9):1294-7. [QxMD MEDLINE Link].
Refaat MM, Katz WE. Neoplastic pericardial effusion. Clin Cardiol. 2011 Oct. 34(10):593-8. [QxMD MEDLINE Link].
Nugue O, Millaire A, Porte H, et al. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. Circulation. 1996 Oct 1. 94(7):1635-41. [QxMD MEDLINE Link].
Hoit BD. Pericardial disease and pericardial tamponade. Crit Care Med. 2007 Aug. 35(8 Suppl):S355-64. [QxMD MEDLINE Link].
Karia DH, Xing YQ, Kuvin JT, Nesser HJ, Pandian NG. Recent role of imaging in the diagnosis of pericardial disease. Curr Cardiol Rep. 2002 Jan. 4(1):33-40. [QxMD MEDLINE Link].
Horowitz MS, Schultz CS, Stinson EB, Harrison DC, Popp RL. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation. 1974 Aug 1. 50:239-47. [Full Text].
Faehnrich JA, Noone RB Jr, White WD, et al. Effects of positive-pressure ventilation, pericardial effusion, and cardiac tamponade on respiratory variation in transmitral flow velocities. J Cardiothorac Vasc Anesth. 2003 Feb. 17(1):45-50. [QxMD MEDLINE Link].
Taguchi R, Takasu J, Itani Y, et al. Pericardial fat accumulation in men as a risk factor for coronary artery disease. Atherosclerosis. 2001 Jul. 157(1):203-9. [QxMD MEDLINE Link].
Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab. 2005 Nov. 90(11):6300-2. [QxMD MEDLINE Link].
Restrepo CS, Lemos DF, Lemos JA, et al. Imaging findings in cardiac tamponade with emphasis on CT. Radiographics. 2007 Nov-Dec. 27(6):1595-610. [QxMD MEDLINE Link].
Watanabe A, Hara Y, Hamada M, et al. A case of effusive-constructive pericarditis: an efficacy of GD-DTPA enhanced magnetic resonance imaging to detect a pericardial thickening. Magn Reson Imaging. 1998 Apr. 16(3):347-50. [QxMD MEDLINE Link].
Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003 Aug 14. 349(7):684-90. [QxMD MEDLINE Link].
Bruch C, Schmermund A, Dagres N, et al. Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment. J Am Coll Cardiol. 2001 Jul. 38(1):219-26. [QxMD MEDLINE Link].
[Guideline] Maisch B, Seferovic PM, Ristic AD, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology. Eur Heart J. 2004 Apr. 25(7):587-610. [QxMD MEDLINE Link].
Meurin P, Tabet JY, Thabut G, et al. Nonsteroidal anti-inflammatory drug treatment for postoperative pericardial effusion: a multicenter randomized, double-blind trial. Ann Intern Med. 2010 Feb 2. 152(3):137-43. [QxMD MEDLINE Link].
Imazio M, Bobbio M, Cecchi E, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation. 2005 Sep 27. 112(13):2012-6. [QxMD MEDLINE Link].
Imazio M, Cecchi E, Ierna S, Trinchero R. Investigation on colchicine for acute pericarditis: a multicenter randomized placebo-controlled trial evaluating the clinical benefits of colchicine as adjunct to conventional therapy in the treatment and prevention of pericarditis; study design and rationale. J Cardiovasc Med (Hagerstown). 2007 Aug. 8(8):613-7. [QxMD MEDLINE Link].
Maisch B, Ristic AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy. Eur Heart J. 2002 Oct. 23(19):1503-8. [QxMD MEDLINE Link].
Tsang TS, Enriquez-Sarano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002 May. 77(5):429-36. [QxMD MEDLINE Link].
Klein SV, Afridi H, Agarwal D, Coughlin BF, Schielke LH. CT directed diagnostic and therapeutic pericardiocentesis: 8-year experience at a single institution. Emerg Radiol. 2005 Nov. 11(6):353-63. [QxMD MEDLINE Link].
Eichler K, Zangos S, Thalhammer A, et al. CT-guided pericardiocenteses: clinical profile, practice patterns and clinical outcome. Eur J Radiol. 2010 Jul. 75(1):28-31. [QxMD MEDLINE Link].
Palmer SL, Kelly PD, Schenkel FA, Barr ML. CT-guided tube pericardiostomy: a safe and effective technique in the management of postsurgical pericardial effusion. AJR Am J Roentgenol. 2009 Oct. 193(4):W314-20. [QxMD MEDLINE Link].
Motas C, Motas N, Rus O, Horvat T. Left paraxiphoidian approach for drainage of pericardial effusions. Interact Cardiovasc Thorac Surg. 2010 Jan. 10(1):4-5. [QxMD MEDLINE Link]. [Full Text].
Palma JH, Gaia DF, Guilhen JC, et al. Video-thoracoscopic pericardial drainage in the treatment of pericardial effusions. Rev Bras Cir Cardiovasc. 2009 Mar. 24(1):44-9. [QxMD MEDLINE Link]. [Full Text].
Allen KB, Faber LP, Warren WH. Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage. Ann Thorac Surg. 1999 Feb. 67(2):437-40. [QxMD MEDLINE Link].
Artom G, Koren-Morag N, Spodick DH, et al. Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis. Eur Heart J. 2005 Apr. 26(7):723-7. [QxMD MEDLINE Link].
Barbaro G. Cardiovascular manifestations of HIV infection. Circulation. 2002 Sep 10. 106(11):1420-5. [QxMD MEDLINE Link].
Moore KL, Persaud TVN. Before We Are Born: Essentials of Embryology and Birth Defects. 4th ed. Philadelphia: W B Saunders Co; 1993.
Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P. Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur Heart J. 2000 May. 21(10):832-6. [QxMD MEDLINE Link].
Braunwald E. Cardiology: how did we get here, where are we today and where are we going?. Can J Cardiol. 2005 Oct. 21(12):1015-7. [QxMD MEDLINE Link].
Lorell B. Pericardial diseases. Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 5th ed. Philadelphia: WB Saunders Company; 1997. 1478-96.
[Guideline] Cheitlin MD, Alpert JS, Armstrong WF. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in coll. Circulation. 1997 Mar 18. 95(6):1686-744. [QxMD MEDLINE Link].
Chen Y, Brennessel D, Walters J. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J. 1999 Mar. 137(3):516-21. [QxMD MEDLINE Link].
Chong HH, Plotnick GD. Pericardial effusion and tamponade: evaluation, imaging modalities, and management. Compr Ther. 1995 Jul. 21(7):378-85. [QxMD MEDLINE Link].
Eisenberg MJ, de Romeral LM, Heidenreich PA. The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment. Chest. 1996 Aug. 110(2):318-24. [QxMD MEDLINE Link].
Fagan SM, Chan KL. Pericardiocentesis: blind no more! [editorial; comment]. Chest. 1999 Aug. 116(2):275-6. [QxMD MEDLINE Link].
Feigenbaum, H. Echocardiography. 5th ed. Philadelphia: Lea & Febiger; 1994: 556-74.
Flores RM, Jaklitsch MT, DeCamp MM Jr. Video-assisted thoracic surgery pericardial resection for effusive disease. Chest Surg Clin N Am. 1998 Nov. 8(4):835-51. [QxMD MEDLINE Link].
Guberman BA, Fowler NO, Engel PJ. Cardiac tamponade in medical patients. Circulation. 1981 Sep. 64(3):633-40. [QxMD MEDLINE Link].
Heidenreich PA, Eisenberg MJ, Kee LL. Pericardial effusion in AIDS. Incidence and survival. Circulation. 1995 Dec 1. 92(11):3229-34. [QxMD MEDLINE Link].
Ilan Y, Oren R, Ben-Chetrit E. Etiology, treatment, and prognosis of large pericardial effusions. A study of 34 patients. Chest. 1991 Oct. 100(4):985-7. [QxMD MEDLINE Link].
Imazio M, Demichelis B, Cecchi E, et al. Cardiac troponin I in acute pericarditis. J Am Coll Cardiol. 2003 Dec 17. 42(12):2144-8. [QxMD MEDLINE Link].
Imazio M, Demichelis B, Parrini I, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol. 2004 Mar 17. 43(6):1042-6. [QxMD MEDLINE Link].
Kasper D, Branunwald E, Fauci AS, Hauser S, Longo D, Jameson JL. Harrison's Principles of Internal Medicine. 16th ed. New York: McGraw-Hill Professional; 2005. 1414-20.
Kimberly RP. Treatment. Corticosteroids and anti-inflammatory drugs. Rheum Dis Clin North Am. 1988 Apr. 14(1):203-21. [QxMD MEDLINE Link].
Kocheril AG, Luttmann C, Sadaniantz A. Pneumococcal pericarditis successfully treated with catheter drainage and intravenous antibiotics. Cathet Cardiovasc Diagn. 1991 Dec. 24(4):286-7. [QxMD MEDLINE Link].
Lange RA, Hillis LD. Clinical practice. Acute pericarditis. N Engl J Med. 2004 Nov 18. 351(21):2195-202. [QxMD MEDLINE Link].
Little WC, Freeman GL. Pericardial disease. Circulation. 2006 Mar 28. 113(12):1622-32. [QxMD MEDLINE Link].
Maher EA, Shepherd FA, Todd TJ. Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade. J Thorac Cardiovasc Surg. 1996 Sep. 112(3):637-43. [QxMD MEDLINE Link].
Maisch B. Pericardial diseases, with a focus on etiology, pathogenesis, pathophysiology, new diagnostic imaging methods, and treatment. Curr Opin Cardiol. 1994 May. 9(3):379-88. [QxMD MEDLINE Link].
Maisch B, Ristic AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy. Eur Heart J. 2002 Oct. 23(19):1503-8. [QxMD MEDLINE Link].
Mangan CM. Malignant pericardial effusions: pathophysiology and clinical correlates. Oncol Nurs Forum. 1992 Sep. 19(8):1215-21. [QxMD MEDLINE Link].
Maruyama R, Yokoyama H, Seto T, et al. Catheter drainage followed by the instillation of bleomycin to manage malignant pericardial effusion in non-small cell lung cancer: a multi-institutional phase II trial. J Thorac Oncol. 2007 Jan. 2(1):65-8. [QxMD MEDLINE Link].
Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. 2005 Dec 6. 112(23):3608-16. [QxMD MEDLINE Link].
Merce J, Sagrista-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J. 1999 Oct. 138(4 Pt 1):759-64. [QxMD MEDLINE Link].
Meyers DG, Bagin RG, Levene JF. Electrocardiographic changes in pericardial effusion. Chest. 1993 Nov. 104(5):1422-6. [QxMD MEDLINE Link].
Meyers DG, Meyers RE, Prendergast TW. The usefulness of diagnostic tests on pericardial fluid. Chest. 1997 May. 111(5):1213-21. [QxMD MEDLINE Link].
Naqvi TZ, Huynh HK. A new window of opportunity in echocardiography. J Am Soc Echocardiogr. 2006 May. 19(5):569-77. [QxMD MEDLINE Link].
Nugue O, Millaire A, Porte H. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. Circulation. 1996 Oct 1. 94(7):1635-41. [QxMD MEDLINE Link].
Pankuweit S, Ristic AD, Seferovic PM, Maisch B. Bacterial pericarditis: diagnosis and management. Am J Cardiovasc Drugs. 2005. 5(2):103-12. [QxMD MEDLINE Link].
Press OW, Livingston R. Management of malignant pericardial effusion and tamponade. JAMA. 1987 Feb 27. 257(8):1088-92. [QxMD MEDLINE Link].
Retter AS. Pericardial disease in the oncology patient. Heart Dis. 2002 Nov-Dec. 4(6):387-91. [QxMD MEDLINE Link].
Ruiz-Garcia J, Jimenez-Valero S, Moreno R, et al. Percutaneous balloon pericardiotomy as the initial and definitive treatment for malignant pericardial effusion. Rev Esp Cardiol (Engl Ed). 2013 May. 66(5):357-63. [QxMD MEDLINE Link].
Sagrista-Sauleda J, Angel J, Permanyer-Miralda G. Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med. 1999 Dec 30. 341(27):2054-9. [QxMD MEDLINE Link].
Shabetai R. Recurrent pericarditis: recent advances and remaining questions. Circulation. 2005 Sep 27. 112(13):1921-3. [QxMD MEDLINE Link].
Silva-Cardoso J, Moura B, Martins L. Pericardial involvement in human immunodeficiency virus infection. Chest. 1999 Feb. 115(2):418-22. [QxMD MEDLINE Link].
Spodick DH. Acute pericarditis: current concepts and practice. JAMA. 2003 Mar 5. 289(9):1150-3. [QxMD MEDLINE Link].
Spodick DH. Intrapericardial treatment of persistent autoreactive pericarditis/myopericarditis and pericardial effusion. Eur Heart J. 2002 Oct. 23(19):1481-2. [QxMD MEDLINE Link].
Spodick DH. The technique of pericardiocentesis. When to perform it and how to minimize complications. J Crit Illn. 1995 Nov. 10(11):807-12. [QxMD MEDLINE Link].
Vaitkus PT, Herrmann HC, LeWinter MM. Treatment of malignant pericardial effusion. JAMA. 1994 Jul 6. 272(1):59-64. [QxMD MEDLINE Link].
Weisse AB, Desai RR, Rajihah G. Contrast echocardiography as an adjunct in hemorrhagic or complicated pericardiocentesis. Am Heart J. 1996 Apr. 131(4):822-5. [QxMD MEDLINE Link].
Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC. The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study. Circulation. 1984 Mar. 69(3):506-11. [QxMD MEDLINE Link].
Zhang P, Liegeois NJ, Wong C, et al. Altered cell differentiation and proliferation in mice lacking p57KIP2 indicates a role in Beckwith-Wiedemann syndrome. Nature. 1997 May 8. 387(6629):151-8. [QxMD MEDLINE Link].
Fenstad ER, Le RJ, Sinak LJ, et al. Pericardial effusions in pulmonary arterial hypertension: characteristics, prognosis, and role of drainage. Chest. 2013 Nov. 144(5):1530-8. [QxMD MEDLINE Link].
Celik S, Lestuzzi C, Cervesato E, et al. Systemic chemotherapy in combination with pericardial window has better outcomes in malignant pericardial effusions. J Thorac Cardiovasc Surg. 2014 Nov. 148(5):2288-93. [QxMD MEDLINE Link].
Andreasen JJ, Sorensen GV, Abrahamsen ER, et al. Early chest tube removal following cardiac surgery is associated with pleural and/or pericardial effusions requiring invasive treatment. Eur J Cardiothorac Surg. 2016 Jan. 49(1):288-92. [QxMD MEDLINE Link].
Izadi Amoli A, Bozorgi A, HajHossein et al. Efficacy of colchicine versus placebo for the treatment of pericardial effusion after open-heart surgery: A randomized, placebo-controlled trial. Am Heart J. 2015 Dec. 170(6):1195-201. [QxMD MEDLINE Link].
Sagrista-Sauleda J, Merce AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol. 2011 May 26. 3(5):135-43. [QxMD MEDLINE Link].
Alerhand S, Carter JM. What echocardiographic findings suggest a pericardial effusion is causing tamponade?. Am J Emerg Med. 2018 Nov 17. [QxMD MEDLINE Link].
Kazantzis T, Bibas BJ, Dela-Vega AJ, et al. Predictors of hospital discharge in cancer patients with pericardial effusion undergoing surgical pericardial drainage. J Surg Oncol. 2018 Nov 22. [QxMD MEDLINE Link].

Media Gallery

This image is from a patient with malignant pericardial effusion. Note the "water-bottle" appearance of the cardiac silhouette in the anteroposterior (AP) chest film.
Echocardiogram (parasternal, long axis) of a patient with a moderate pericardial effusion.
This image is from a patient with malignant pericardial effusion. The effusion is seen as an echo-free region to the right of the left ventricle (LV).
This electrocardiogram (ECG) is from a patient with malignant pericardial effusion. The ECG shows diffuse low voltage, with a suggestion of electrical alternans in the precordial leads.
Subcostal view of an echocardiogram that shows a moderate to large amount of pericardial effusion.
This echocardiogram shows a large amount of pericardial effusion (identified by the white arrows).

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Author

William J Strimel, DO, FACP Cardiologist, Lehigh Valley Heart Specialists

William J Strimel, DO, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

Bilal Ayub, MD Chief Cardiology Fellow, Division of Cardiology, Department of Internal Medicine, Lehigh Valley Health Network

Bilal Ayub, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Echocardiography, National Lipid Association, American Society of Nuclear Cardiology

Disclosure: Nothing to disclose.

Tahmeed Contractor, MD Fellow, Division of Cardiology, Department of Internal Medicine, Lehigh Valley Health Network

Tahmeed Contractor, MD is a member of the following medical societies: American College of Cardiology, Indian Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Terrence X O'Brien, MD, MS, FACC Professor of Medicine/Cardiology, Director, Clinical Cardiovascular Research, Medical University of South Carolina College of Medicine; Director, Echocardiography Laboratory, Veterans Affairs Medical Center of Charleston

Terrence X O'Brien, MD, MS, FACC is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Ramin Assadi, MD, Senior Fellow, Department of Cardiology, Loma Linda University School of Medicine

Ramin Assadi, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Abraham G Kocheril, MD, FACC, FACP, FHRS Professor of Medicine, University of Illinois College of Medicine

Abraham G Kocheril, MD, FACC, FACP, FHRS is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Cardiac Electrophysiology Society, Central Society for Clinical Research, Heart Failure Society of America, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Ronald J Oudiz, MD, FACP, FACC, FCCP Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting

Justin D Pearlman, MD, PhD, ME, MA Director of Advanced Cardiovascular Imaging, Professor of Medicine, Professor of Radiology, Adjunct Professor, Thayer Bioengineering and Computer Science, Dartmouth-Hitchcock Medical Center

Justin D Pearlman, MD, PhD, ME, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America

Disclosure: Nothing to disclose.

Ali A Sovari, MD, FACP, Clinical and Research Fellow in Cardiovascular Medicine, Section of Cardiology, University of Illinois College of Medicine; Staff Physician and Hospitalist, St John Regional Medical Center, Cogent Healthcare, Inc

Ali A Sovari, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Physiological Society, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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