Methodist Debakey Cardiovasc J
· 2026 · PMID 41835355
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Post-cardiac injury syndrome (PCIS) encompasses inflammatory pericardial syndromes occurring after cardiac injury, including post-pericardiotomy syndrome (PPS) following cardiac surgery, post-myocardial infarction (Dress...Post-cardiac injury syndrome (PCIS) encompasses inflammatory pericardial syndromes occurring after cardiac injury, including post-pericardiotomy syndrome (PPS) following cardiac surgery, post-myocardial infarction (Dressler syndrome), and post-traumatic pericarditis. With the expanding use of cardiac surgical and interventional procedures, PCIS has become increasingly prevalent despite a marked decline in Dressler syndrome in the contemporary reperfusion era. The syndrome is believed to result from an immune-mediated inflammatory response to myocardial and pericardial injury, leading to pericarditis with associated pericardial and, often, pleural effusions. Clinical presentation typically occurs days to weeks after the inciting event and includes fever, pleuritic chest pain, elevated inflammatory markers, and imaging evidence of pericardial effusion. Early recognition is essential, as prompt treatment can relieve symptoms and prevent complications such as cardiac tamponade or progression to constrictive pericarditis. First-line therapy consists of high-dose aspirin or nonsteroidal anti-inflammatory drugs combined with colchicine, which accelerates symptom resolution and reduces recurrence. In refractory or recurrent cases, corticosteroids or interleukin-1 inhibitors, such as anakinra, are effective. Prophylactic colchicine administered around the time of cardiac surgery significantly reduces the incidence of post-pericardiotomy syndrome. This review summarizes current evidence and incorporates the 2025 European Society of Cardiology guidelines to guide optimal evaluation and management of PCIS.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835354
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Recurrent pericarditis is a heterogeneous and often debilitating inflammatory disorder characterized by recurrent flares following a symptom-free interval of at least 4 to 6 weeks. Although most cases in developed countr...Recurrent pericarditis is a heterogeneous and often debilitating inflammatory disorder characterized by recurrent flares following a symptom-free interval of at least 4 to 6 weeks. Although most cases in developed countries are idiopathic or post-viral, the condition may arise from autoimmune disease, post-cardiac injury syndromes, infection, or systemic inflammatory disorders. Traditional management with nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids has historically provided symptomatic relief but is limited by high recurrence rates, steroid dependence, and substantial morbidity. Over the past decade, growing recognition of the central autoinflammatory mechanisms-particularly NOD-like receptor 3 (NLRP3) inflammasome activation and interleukin (IL-1)-mediated signaling-has transformed the therapeutic approach to this condition. The introduction of IL-1 inhibitors, including anakinra and rilonacept, has reshaped contemporary practice by reducing recurrence rates, minimizing corticosteroid dependence, and establishing a precision-based approach to disease activity-guided therapy. The purpose of this review is to synthesize contemporary evidence surrounding the pathophysiology and evolving treatment paradigms for recurrent pericarditis, with a focus on novel targeted therapies.
El Harake L, Al-Kazaz M, Cremer PC
… +1 more, Johnston DR
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835353
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Constrictive pericarditis represents a form of severe diastolic heart failure characterized by impaired diastolic filling due to a rigid, noncompliant pericardium. Surgical pericardiectomy is the definitive treatment for...Constrictive pericarditis represents a form of severe diastolic heart failure characterized by impaired diastolic filling due to a rigid, noncompliant pericardium. Surgical pericardiectomy is the definitive treatment for chronic or refractory subacute constrictive pericarditis; however, outcomes vary widely depending on disease etiology, chronicity, myocardial involvement, end-organ dysfunction, and surgical technique. This review summarizes contemporary best practices for the surgical management of constrictive pericarditis, with emphasis on patient selection, timing of intervention, operative approach, and perioperative considerations. Accurate differentiation between inflammatory, transient constrictive phenotypes and irreversible fibrotic disease is central to therapeutic decision-making. Etiology-based risk stratification, assessment of hepatic and renal dysfunction, and careful evaluation of myocardial involvement provide critical prognostic information. Multimodality imaging plays a central role in diagnosis, surgical planning, and identification of patients most likely to benefit from intervention. Radical pericardiectomy is associated with superior functional recovery compared with partial resection, whereas radiation-associated disease, mixed constrictive-restrictive physiology, and advanced end-organ dysfunction are consistently linked to worse outcomes. High-volume centers of excellence in pericardial disease are critical in optimizing results after radical pericardiectomy.
Baser K, Ali N, Fakikh Y
… +4 more, Al-Kindi S, Al-Mallah M, Shah D, Malahfji M
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835351
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Pericardial diseases span a spectrum from acute and recurrent pericarditis to chronic constrictive pericarditis. While echocardiography remains the first-line test in the evaluation of patients with suspected pericardial...Pericardial diseases span a spectrum from acute and recurrent pericarditis to chronic constrictive pericarditis. While echocardiography remains the first-line test in the evaluation of patients with suspected pericardial disease, advanced cardiac imaging with cardiac magnetic resonance and computed tomography have become complementary and often essential in refining diagnosis and guiding management in many patients. The recent Concise Clinical Guidance Statement from the American College of Cardiology as well as updated European Society of Cardiology guidelines have given new emphasis and recommendations on the use of advanced imaging in both pericarditis and pericardial constriction. This review summarizes the techniques, indications, and recent studies on the use of advanced cardiac imaging in pericarditis and pericardial constriction.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835350
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Jane Kenyon (1947-1995) died from leukemia in 1995, a writer in her prime whose work was steadily rising in popularity and amassing critical acclaim. Earlier that year, she had been appointed Poet Laureate of New Hampshi...Jane Kenyon (1947-1995) died from leukemia in 1995, a writer in her prime whose work was steadily rising in popularity and amassing critical acclaim. Earlier that year, she had been appointed Poet Laureate of New Hampshire and left behind a rich body of work, including "Otherwise"-the featured work in this Poet's Pen. Kenyon was married to fellow writer Donald Hall (1928-2018) and wrote this piece in response to her husband's presumptively terminal cancer diagnosis. Though Hall's writings have been used extensively in the medical humanities, an argument can be made that several of Kenyon's works are just as worthy of inclusion. Many of her poems provide important insights into topics like bereavement, caregiving, and mental illness, making them ideally suited for consideration as part of health humanities education.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835349
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Initially recognized as a key cardiac feature of systemic lupus erythematosus and rheumatoid arthritis, autoimmune pericarditis has gained increasing attention given the recent advances in cardiac imaging, biomarker asse...Initially recognized as a key cardiac feature of systemic lupus erythematosus and rheumatoid arthritis, autoimmune pericarditis has gained increasing attention given the recent advances in cardiac imaging, biomarker assessment, and understanding of immune-mediated mechanisms. The prevalence of pericardial involvement varies considerably among autoimmune diseases. Patients may have a small pericardial effusion that remains clinically silent but could also present with acute, recurrent, or chronic pericarditis. A minority develop severe complications such as tamponade or constrictive physiology. Characterizing autoimmune pericarditis is critical, particularly in an era of expanding immunomodulatory therapies. This review summarizes current knowledge on prevalence, pathophysiology, clinical presentation, and diagnostic strategies, with a particular focus on emerging therapeutics in pericardial disease associated with autoimmune disorders. Integrating rheumatology and cardiology expertise is essential to optimize the care of this heterogeneous patient population.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835348
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Philip Alexander, MD, is a native Texan, retired physician, and accomplished musician and artist. After 41 years as an internal medicine physician, Dr. Phil retired from his practice in College Station in 2016. A lifelon...Philip Alexander, MD, is a native Texan, retired physician, and accomplished musician and artist. After 41 years as an internal medicine physician, Dr. Phil retired from his practice in College Station in 2016. A lifelong musician and former music professor, he often performs as an oboe soloist for the Brazos Valley Symphony Orchestra. He began exploring visual art in 1980, evolving from pencil sketches-including an official White House portrait of President Ronald Reagan-to the computer-generated drawings featured in this journal. His images, which first appeared in this journal in the spring of 2012, are his own original creations. This issue of the also includes an artistic submission by Muhammad Umair, MD, assistant professor of radiology at the New York Presbyterian Hospital-Columbia University, whose work focuses on cardiovascular imaging (MRI and CT). He adds that he "sometimes indulges in abstract paintings, inspired by his work in cardiac and vascular imaging." If you would like to see your art published in the , submit your creation online at journal.houstonmethodist.org as a "Humanities" entry.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835347
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Pericardial effusion secondary to an underlying neoplasm carries a poor prognosis because it often represents an advanced stage of malignancy. In approximately one-third of affected patients, the initial presentation may...Pericardial effusion secondary to an underlying neoplasm carries a poor prognosis because it often represents an advanced stage of malignancy. In approximately one-third of affected patients, the initial presentation may be cardiac tamponade.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835346
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Constrictive pericarditis (CP) represents a spectrum of pericardial diseases characterized by impaired ventricular filling due to a noncompliant pericardium. Within this continuum, effusive constrictive pericarditis (ECP...Constrictive pericarditis (CP) represents a spectrum of pericardial diseases characterized by impaired ventricular filling due to a noncompliant pericardium. Within this continuum, effusive constrictive pericarditis (ECP) and transient constrictive pericarditis are characterized by active inflammation. ECP combines pericardial effusion and constrictive physiology, whereas transient constrictive pericarditis is characterized by resolution, often after anti-inflammatory therapy. These conditions often result from idiopathic, post-surgical, autoimmune, or tuberculous causes and may progress from acute inflammation to chronic fibrosis and calcification, termed chronic constrictive pericarditis. Multimodality imaging, including echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography, plays a key role in establishing the diagnosis, assessing inflammation, and guiding treatment. In patients with active pericardial inflammation, increasing evidence and practice supports the early and combined initiation of anti-inflammatory therapy including nonsteroidal agents, colchicine, corticosteroids, and interleukin-1 inhibitors to reverse constrictive pathophysiology.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835345
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Pericardial effusion represents a common clinical entity encountered across diverse medical settings, with presentations ranging from incidental findings to life-threatening cardiac tamponade. The accurate diagnosis and...Pericardial effusion represents a common clinical entity encountered across diverse medical settings, with presentations ranging from incidental findings to life-threatening cardiac tamponade. The accurate diagnosis and management of pericardial effusion and its hemodynamically significant sequelae demand a comprehensive multimodality imaging approach. Echocardiography remains the cornerstone of initial evaluation, providing real-time assessment of effusion size, hemodynamic impact, and guidance for therapeutic interventions. This review synthesizes contemporary evidence from major cardiology societies to present a structured approach to the diagnosis and management of pericardial effusion and tamponade. We emphasize the pivotal role of echocardiography while integrating complementary modalities, including cardiac computed tomography and cardiac magnetic resonance imaging. Key echocardiographic findings, Doppler parameters, and imaging-guided therapeutic strategies are discussed in detail, with attention to emerging techniques and evidence-based algorithms. Understanding the multimodality imaging approach is essential for optimizing patient outcomes in this potentially life-threatening condition.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835344
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Relapsing pericarditis (RP) is a chronic inflammatory disorder characterized by two or more episodes of acute pericarditis flares after a minimum of a 4-week symptom-free period. Recurrent pericarditis develops in approx...Relapsing pericarditis (RP) is a chronic inflammatory disorder characterized by two or more episodes of acute pericarditis flares after a minimum of a 4-week symptom-free period. Recurrent pericarditis develops in approximately 15% to 30% of patients following an initial episode of acute pericarditis, and nearly half of these individuals experience subsequent recurrences. Although the course is heterogeneous, RP has substantial morbidity and impaired quality of life implications and is associated with pericardial complications, including cardiac tamponade and constrictive pericarditis. This review summarizes current knowledge about clinical perspectives, predictors, and risk stratification tools for relapses in RP and critically appraises the evolving role of exercise restriction as part of RP management. Many adverse prognosticators for RP in clinical, laboratory, multimodality cardiac imaging, and treatment factors have been identified from clinical trials, observational studies, and experiences of managing RP patients. Several risk scores have been recently developed to assist in risk stratification and treatment guidance for RP patients, such as the Athens, Torino, INFLA, and Klein scores. There is also growing evidence for exercise restriction strategies with a focus on practical individualized strategies in the multimodal treatment of RP that have been included in recent pericarditis guidance documents. Multicenter external validation and randomized trials remain necessary to assess the roles and performance of risk scores and exercise restriction in treating RP to improve their clinical outcomes.
Zeitoun J, Fakih Y, Khan S
… +2 more, Jilani T, Malahfji M
Methodist Debakey Cardiovasc J
· 2026 · PMID 41835343
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Multimodality imaging is used to diagnose a patient with prior acute pericarditis and demonstrated effusive-constrictive physiology characterized by pericardial thickening with effusion, pericardial enhancement consisten...Multimodality imaging is used to diagnose a patient with prior acute pericarditis and demonstrated effusive-constrictive physiology characterized by pericardial thickening with effusion, pericardial enhancement consistent with active inflammation, and ventricular interdependence. These findings highlight the complementary role of cardiac magnetic resonance in the diagnosis and management of inflammatory constrictive pericardial disease.
J A, Choudhary AK, Rao N
… +2 more, Rao S, Kumar D
Methodist Debakey Cardiovasc J
· 2026 · PMID 41800376
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A 49-year-old man presented with acute onset chest pain and new-onset right bundle branch block. Echocardiography revealed mild apical hypokinesia with an ejection fraction of 45%. Coronary angiography showed all three m...A 49-year-old man presented with acute onset chest pain and new-onset right bundle branch block. Echocardiography revealed mild apical hypokinesia with an ejection fraction of 45%. Coronary angiography showed all three major coronary arteries originating from the right coronary sinus with normal flow. Further evaluation identified an obstructed accessory left anterior descending (LAD) artery arising from the left sinus. Successful wire crossing, balloon dilatation, and deployment of a drug-eluting stent restored TIMI 3 flow. Subsequent computed tomography angiography confirmed a rare Type X dual LAD anatomy. This case highlights the importance of recognizing uncommon coronary artery anomalies since they may significantly influence diagnostic and therapeutic strategies.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41725857
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Partial congenital pericardial defects are exceptionally uncommon and typically asymptomatic. In rare circumstances, cardiac herniation through the defect may precipitate mechanical strangulation with extrinsic coronary...Partial congenital pericardial defects are exceptionally uncommon and typically asymptomatic. In rare circumstances, cardiac herniation through the defect may precipitate mechanical strangulation with extrinsic coronary artery compression and myocardial infarction (MI). We describe a young man who presented with ST-elevation MI attributed to left ventricular (LV) herniation through a previously unrecognized pericardial defect. Despite a typical clinical presentation of MI, the highly atypical angiographic and echocardiographic findings required further investigation. Cardiac magnetic resonance was crucial for excluding alternative causes of LV wall thickening and coronary artery compression, such as tumors or infiltrative diseases, and contributed to identifying the pericardial defect. Although rare, partial pericardial defects should be considered in the differential diagnosis of acute coronary syndrome, especially in young patients with atypical presentations or findings.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41695025
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Coronary artery fistulas represent abnormal connections between the coronary arterial system and cardiac chambers or other vascular structures. Depending on various morphological characteristics of the fistula, the clini...Coronary artery fistulas represent abnormal connections between the coronary arterial system and cardiac chambers or other vascular structures. Depending on various morphological characteristics of the fistula, the clinical presentation may vary from being asymptomatic to having clinically significant myocardial ischemia. The present case highlights a rare instance of a right coronary artery to coronary sinus fistula with a giant coronary sinus aneurysm.
Quiñones MA, Lumsden A, Corr S
… +4 more, Watson J, Roy TL, Bavare C, Tavallaei MA
Methodist Debakey Cardiovasc J
· 2025 · PMID 41694042
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This 55-minute webcast features a conversation about "Vascular Robotics"-the focus of Issue 21.5. Led by the issue's editors, the discussion engages the authors on emerging themes and lessons learned while researching an...This 55-minute webcast features a conversation about "Vascular Robotics"-the focus of Issue 21.5. Led by the issue's editors, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles. View the video at https://vimeo.com/event/5556427.
Sharma A, Verma M, Paul S
… +3 more, Gadre A, Kumar Rohit M, Singhal M
Methodist Debakey Cardiovasc J
· 2026 · PMID 41623686
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Intramyocardial lipomas are rare benign cardiac tumors that often present a diagnostic dilemma due to their nonspecific clinical and imaging features on initial evaluation. We report the case of a 40-year-old asymptomati...Intramyocardial lipomas are rare benign cardiac tumors that often present a diagnostic dilemma due to their nonspecific clinical and imaging features on initial evaluation. We report the case of a 40-year-old asymptomatic male who presented with a large intramyocardial lipoma arising from the basal inferior wall of the left ventricle. Initial transthoracic echocardiography revealed an echogenic mass in the region of the left ventricle basal septum but was insufficient for definite characterization. Cross-sectional imaging, including computed tomography (CT) and cardiac magnetic resonance imaging (MRI), demonstrated a homogeneous fat-density mass consistent with lipoma. This case highlights the pivotal role of multimodality imaging in accurately characterizing a rare primary cardiac tumor.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41583857
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We report a case of a 49-year-old female who presented with atypical chest pain. An electrocardiogram-gated coronary computed tomography angiography revealed the absence of the left main coronary artery segment with dire...We report a case of a 49-year-old female who presented with atypical chest pain. An electrocardiogram-gated coronary computed tomography angiography revealed the absence of the left main coronary artery segment with direct origin of the left anterior descending artery and the left circumflex artery from the left coronary sinus having separate ostia. The case highlights a rare anomaly of coronary artery origin with procedural implications.
Methodist Debakey Cardiovasc J
· 2026 · PMID 41542142
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This 11-minute video aims at improving skills for the structural assessment of sinus venosus defects using 2-dimensional transthoracic echocardiography (TTE) to increase the ability to diagnose-or rule out-the different...This 11-minute video aims at improving skills for the structural assessment of sinus venosus defects using 2-dimensional transthoracic echocardiography (TTE) to increase the ability to diagnose-or rule out-the different types of interatrial communications. Of the five types of lesions, this video focuses on superior and inferior sinus venosus defects. This is the second video in our MicroLearning Video Series, designed to help a target audience of sonographers, general cardiologists, general practitioners who want to gain knowledge on fundamental cardiology, and technicians. View the video at https://vimeo.com/1153585209.