The CHASER pathway for the management of
Pericardial Diseases
Acute
Subacute
Hypotension,
CHest pain
Shortness of
PEA
Echo or imaging
breath
syncope,
Arrest
chronic
of pericardial
effusion
Right
Predominant
Heart Failure
1
Clinical
Type :
2
Physical
Tachycardia
Pulsus paradoxus
JVD
Clear lungs
Friction Rub
3
ST elevation
PR depression (T1)
EKG
4
Echo
High Risk
Etiologies for
Constrictive
Pericarditis (T4)
Assess for
Etiology (T3)
High risk
conditions for
tamponade
(T2)
Sharp
Pleuritic
Positional
Kussmaul sign
Pericardial “knock”
Right heart failure findings
Clear lungs
Stable vital
signs
Low Voltage QRS
Electrical Alternans
Low voltage QRS
Non-specific STT changes
Atrial fibrillation
Echocardiographic findings
suggestive of constrictive
pericarditis (T5)
Any significant effusion
Diagnostic
workup
criteria ≥2/4
≥2/4 criteria
Acute Pericarditis
TIER 1 TESTS
CBC, BMP, LFTs,
Coagulation profile CXR
Inflammatory markers
Cardiac enzymes
TIER 1 TESTS
TST/Quantiferone
CBC, Basic metabolic
Echocardiography
panel, liver function
tests, PT,PTT, ESR,
CRP, Cardiac
biomarkers, TSH,
PPD/Quantiferone ,
Medical
management
CXR
Tamponade
Hemodynamic
compromise
Etiologies
Echo Hemodynamic
Findings
RA Collapse >1/3 cardiac cycle
1 pt
Malignant
RV Diastolic Collapse 2 pts
- TEE
- CT/MRI
- Cardiac Catheterization
1 pt
HIV/Immunocompromise 1pt
IF YES -
Non-Dx TIER2 tests 1 pt
Respiratory flow variation >25%
across MV 1pt
Constrictive
Pericarditis
Failing Rx 1 pt
Recurrent 1 pt
IVC plethora 1pt
Max of 3 pts for the above
Criteria
Recent onset, acute
inflammatory component
No
Idiopathic/Viral Inflammatory
Pericarditis Rx:
Ibuprofen 800 mg Q6-8h 7-10
days OR aspirin 800 mg Q6-8h
7-10 days PLUS Colchicine 1-2
mg first day followed by 0.5
mg daily or BID for 3 months
AVOID corticosteroids
Persistent symptoms
in one week (fever,
pain, weight loss) or
increasing effusion
TIER 2 TESTS
ANA/AutoAb
HIV, TSH, Blood
Cultures
CT/MRI
Evidence
of high
pressures
after
drainage?
EffusiveConstrictive
Pericarditis
consider
Treat specific
etiology
Yes
Ibuprofen 800 mg Q6-8h
7-10 days OR aspirin 800
mg Q6-8h 7-10 days
Found
specific
PLUS
Colchicine
1-2 mg
etiology?
first
day followed by 0.5
mg daily or BID for 3
months
AVOID corticosteroids
OR
Yes
Treat specific etiology
If found (e.g. TB)
Score ≥4
Invasive
management
Consider
Aortic Dissection 4 pts
Purulent effusion 4 pts
Trauma 4 pts
Pericardial
drainage
Surgical
Management