Pericardial effusion natural history

Jump to navigation Jump to search

Pericardial effusion Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Pericardial effusion from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Cardiac Catheterization

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Pericardial Window

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Pericardial effusion natural history On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Google Images

American Roentgen Ray Society Images of Pericardial effusion natural history

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pericardial effusion natural history

CDC on Pericardial effusion natural history

Pericardial effusion natural history in the news

Blogs on Pericardial effusion natural history

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Pericardial effusion natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S., Abdelrahman Ibrahim Abushouk, MD[2]

Overview

Patients with uncomplicated pericarditis usually have a self-resolving course within 2 weeks and can be managed on an outpatient basis. However Cardiac tamponade, purulent pericardial effusion, immunocompromised state, history of cancer, dialysis, use of oral anti-coagulation require urgent intervention. The prognosis of pericardial effusion depends on the underlying etiology being especially poor in patients with neoplastic pericardial effusion and very good in idiopathic/viral pericarditis.

Natural history, Complications and Prognosis

Natural History

  • Pericardial effusion if untreated or if refractory to treatment can lead to accumulation of large amount of fluid around the heart, severe hemodynamic compromise and even death.

Complications

  • Many times, there are no complications of pericardial effusion.
  • The most serious possible complication is cardiac tamponade.
  • If untreated, it can lead to shock which can cause serious complications.
  • If the fluid accumulates too rapidly or is too large, then cardiac tamponade, a condition in which the heart is compressed by the fluid and cannot pump enough blood forward may occur. Cardiac tamponade require urgent intervention including pericardiocentesis. This complication is more common in patients with specific underlying etiologies such as malignancy, tuberculosis[1], or purulent effusion and rarely occurs in idiopathic pericardial effusion.
  • Various complications depend on the etiology of the disease:
    • Idiopathic Cause
      • Idiopathic pericardidial effusion is often self-limited and most patients recover in 2 weeks to 3 months. Idiopathic or viral pericardial disease is associated with a favorable long-term prognosis[2]with few developing recurrences[3].
    • Tuberculous Cause
      • The mortality rate associated with tuberculous pericardial disease in the preantibiotic era was 80-90%.[4] The mortality rate is currently 8-17%.[5][6] The mortality is 17-34% if the tuberculous pericardial effusion is associated with HIV[7].
    • Traumatic Pericardial Injury
      • In penetrating injuries, pericardial effusion and tamponade may develop rapidly. Early detection and early treatment of cardiac tamponade is associated with a good prognosis. Minor perforations, isolated right ventricular wounds, and a systolic blood pressure more than 50 mm Hg are all associated with better outcomes.
    • Malignancy
      • Pericardial effusion secondary to malignancy is associated with poorer outcomes and a more complicated course.
    • Autoimmune Disease
    • Renal Failure
      • Pericardial disease secondary to renal failure is associated with significant morbidity and may result in hemorrhagic pericardial effusion.[8]

Prognosis

  • If pericardial effusion lasts beyond 6 months, then it is termed as chronic pericardial effusion and is usually well tolerated.
  • The prognosis of pericardial effusion depends on the underlying etiology.

References

  1. Mayosi BM, Burgess LJ, Doubell AF (2005). "Tuberculous pericarditis". Circulation. 112 (23): 3608–16. doi:10.1161/CIRCULATIONAHA.105.543066. PMID 16330703.
  2. Ilan Y, Oren R, Ben-Chetrit E (1991). "Acute pericarditis: etiology, treatment and prognosis. A study of 115 patients". Jpn Heart J. 32 (3): 315–21. PMID 1920818.
  3. Shabetai R (1990). "Acute pericarditis". Cardiol Clin. 8 (4): 639–44. PMID 2249218.
  4. Harvey AM, Whitehill MR. Tuberculous pericarditis. Medicine. 1937; 16: 45–94
  5. Desai HN (1979). "Tuberculous pericarditis. A review of 100 cases". S Afr Med J. 55 (22): 877–80. PMID 472922.
  6. Bhan GL (1980). "Tuberculous pericarditis". J Infect. 2 (4): 360–4. PMID 7185934.
  7. Hakim JG, Ternouth I, Mushangi E, Siziya S, Robertson V, Malin A (2000). "Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients". Heart. 84 (2): 183–8. PMC 1760932. PMID 10908256.
  8. Nicholls, AJ. Heart and Circulation. In: Handbook of Dialysis, Daugirdas, JT, Ing, TS (Eds), Little, Brown and Co., New York 1994. p.149.

Template:WS Template:WH