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| {{Pericardial effusion}} | | {{Pericardial effusion}} |
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| {{CMG}}; {{M.P}} | | {{CMG}}{{AE}} {{M.P}} |
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| ==Overview== | | ==Overview== |
| Pericardial effusion (fluid around the heart) is an abnormal accumulation of fluid in the [[pericardial cavity]]. Because of the limited amount of space in the pericardial cavity, fluid accumulation will lead to an increased intrapericardial pressure and this can negatively affect [[heart]] function. When there is a pericardial effusion with enough pressure to adversely affect heart function, this is called [[cardiac tamponade]]. Pericardial effusion usually results from a disturbed equilibrium between the production and re-absorption of [[pericardial fluid]], or from a structural abnormality that allows fluid to enter the pericardial cavity. Normal levels of pericardial fluid are from 15 to 50 mL.
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| | ==Historical Perspective== |
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| ==Classification== | | ==Classification== |
| Pericardial effusion can be classified broadly into three types, namely [[transudate|transudative]], [[exudative]] and [[hemorrhage|hemorrhagic]]. A fluid secreting malignancy could also be the cause of a pericardial effusion.
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| ==Pathophysiology== | | ==Pathophysiology== |
| Pericardial effusion usually results from a disturbed equilibrium between the production and reabsorption of [[pericardial fluid]]. This can occur in infections and inflammations where there is increased production of pericardial fluid or in [[malignancy]] and [[hypothyroidism]] where there is inadequate drainage of the fluid.
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| ==Causes== | | ==Causes== |
| Pericardial effusion can be classified into [[serous]], [[bloody]] and [[chyle|chylous]] based on the composition of the effusion fluid. [[Infection]]s and [[inflammation]] usually cause serous effusion while bloody effusions are as a result of [[trauma]] to the heart. Though [[iatrogenic]] causes and [[infection]]s are common etiologies, pericardial disease may also be a feature of other disorders such as [[inflammatory bowel disease]]. [[Aortic dissection]] or [[free wall rupture]] should also be considered in patients with unstable hemodynamics and pericardial effusion.
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| ==Differentiating Pericardial Effusion from other Diseases== | | ==Differentiating Pericardial Effusion from Other Diseases== |
| Most pericardial effusions are caused by inflammation of the pericardium, a condition called pericarditis. As the pericardium becomes inflamed, extra fluid is produced, leading to a pericardial effusion. Viral infections are one of the main causes of pericarditis and pericardial effusions. Infections causing pericardial effusions include [[ cytomegalovirus]], [[coxsackie virus]], [[echovirus]], and [[HIV]]. However, other conditions like injury to the pericardium or heart from a medical procedure, [[myocardial infarction]], [[uremia]], [[autoimmune disease]] and [[cancer]] should be considered in differential diagnosis of pericardial effusion.
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| ==Epidemiology and Demographics== | | ==Epidemiology and Demographics== |
| The underlying cause of pericardial effusion depend on the region where the patient is living. While malignancy is the most common cause of pericardial effusion in developed countries, infections such as [[tuberculosis]] and [[HIV]] seems to be the main etiologies of pericardial effusion in developing countries.<ref name="pmid20728703">{{cite journal| author=Maisch B, Ristic A, Pankuweit S| title=Evaluation and management of pericardial effusion in patients with neoplastic disease. | journal=Prog Cardiovasc Dis | year= 2010 | volume= 53 | issue= 2 | pages= 157-63 | pmid=20728703 | doi=10.1016/j.pcad.2010.06.003 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20728703 }} </ref><ref name="pmid10593777">{{cite journal| author=Atar S, Chiu J, Forrester JS, Siegel RJ| title=Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s? | journal=Chest | year= 1999 | volume= 116 | issue= 6 | pages= 1564-9 | pmid=10593777 | doi= | pmc= | url= }} </ref>
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| ==Natural history, Complications and Prognosis== | | ==Risk Factors== |
| 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.
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| | ==Screening== |
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| | ==Natural History, Complications, and Prognosis== |
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| ==Diagnosis== | | ==Diagnosis== |
| ==History and Symptoms== | | ===Diagnostic Study of Choice=== |
| Pericardial effusion is a relatively common finding and sometimes the clinical picture of the patient leads directly to the cause for pericardial effusion. Mild pericardial effusion is a relatively a common finding, especially in elderly women and they are usually asymptomatic.
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| ==Physical examination== | | ===History and Symptoms=== |
| The vital signs of a patient with small pericardial effusion are often normal. Fever suggests an underlying infectious or inflammatory cause, and the presence of a purulent effusion must be ruled out.
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| ==Laboratory Findings== | | ===Physical Examination=== |
| Laboratory investigations for pericardial effusion include the [[leukocyte]] count, [[C-reactive protein]], and [[ESR]] for ruling out inflammatory causes. The [[cardiac troponin]] is elevated if there is an injury to the underlying [[myocardium]], a condition termed as myopericarditis. Diagnostic [[pericardiocentesis]] and [[biopsy]] help in identifying an underlying infectious or malignant process.
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| ==Electrocardiogram== | | ===Laboratory Findings=== |
| The EKG in patients with pericardial effusion may demonstrate low voltages (micro-voltages or short QRS complexes) and [[electrical alternans]].
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| ==Chest X Ray== | | ===Electrocardiogram=== |
| Chest X ray is very less effective to confirm the diagnosis of pericardial effusion unless there is massive effusion.
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| ==Computed Tomography== | | ===X-ray=== |
| CT is a very effective diagnostic tool in cases of pericardial effusion as it helps us to narrow down on the etiology by determining the amount and nature of the pericardial fluid. CT is very useful especially in identifying hemorrhagic effusions or clots within the pericardium. A pericardial effusion is often incidentally noted on CT scans obtained for other indications.
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| ==Magnetic Resonance Imaging== | | ===Echocardiography and Ultrasound=== |
| MRI allow assessment of the entire chest and detection of associated abnormalities in the mediastinum, lungs and adjacent structures. MRI also delineate more precisely the spacial distribution of pericardial effusion in complex pericardial collections. It may be very useful in the investigation of the presence and extension of neoplastic disease.
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| ==Echocardiography== | | ===CT scan=== |
| The role of [[echocardiography]] in the evaluation of the patient is to chracterize the presence, size, location, and hemodynamic impact of a [[pericardial effusion]]. Echocardiography is not needed to diagnose pericarditis. Echocardiography should be performed if there is a suspicion of [[tamponade]] (e.g. [[distended neck veins]], [[pulsus paradoxus]]).
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| | ===MRI=== |
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| | ===Other Imaging Findings=== |
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| | ===Other Diagnostic Studies=== |
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| | ==Treatment== |
| | ===Medical Therapy=== |
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| | === Interventions === |
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| | ===Surgery=== |
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| | ===Primary Prevention=== |
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| | ===Secondary Prevention=== |
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{reflist|2}} |
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |