Pericardial effusion natural history

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

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.

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.


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

Pericardial involvement in scleroderma and rheumatic fever is associated with worse outcomes.

Renal Failure

Pericardial disease secondary to renal failure is associated with significant morbidity and may result in hemorrhagic pericardial effusion.[8]

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.

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