eMedicine Specialties > Cardiology > Pericardial Disease

Pericardial Effusion: Follow-up

Author: William J Strimel, DO, Fellow, Cardiovascular Disease, Scott and White Memorial Hospital
Coauthor(s): Ramin Assadi, MD, Staff Physician, Department of Internal Medicine, Loma Linda University; Ali A Sovari, MD, Research Fellow, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles (UCLA); Abraham G Kocheril, MD, FACC, FACP, Professor of Medicine, Director of Clinical Electrophysiology, University of Illinois at Chicago
Contributor Information and Disclosures

Updated: Sep 9, 2008

Follow-up

Further Inpatient Care

  • Patients with pericardial effusion who present with significant symptoms or cardiac tamponade require emergent treatment and admission to ICU.
  • The pericardial catheter (if placed) should be removed within 24-48 hours to avoid infection.
  • Symptomatic patients should remain hospitalized until definitive treatment is accomplished and/or symptoms have resolved.

Further Outpatient Care

  • Patients should be educated on symptoms of increasing pericardial effusion and should be evaluated whenever these symptoms begin to occur.
  • Indications for echocardiography after diagnosis include the following:
    • A follow-up imaging study to evaluate for recurrence/constriction: Repeat studies may be performed to answer specific clinical questions.
    • The presence of large or rapidly accumulating effusions (to detect early signs of tamponade)

Transfer

Symptomatic patients requiring treatment (who are surgical candidates) should receive care at an institution with cardiothoracic surgery capabilities.

Complications

  • Pericardial tamponade
    • Can lead to severe hemodynamic compromise and death.
    • Heralded by equalization of diastolic filling pressures.
    • Treat with expansion of intravascular volume (small amounts of crystalloids or colloids may lead to improvement, especially in hypovolemic patients) and urgent pericardial drainage. Avoid positive-pressure ventilation if possible, as this decreases venous return and cardiac output. Vasopressor agents are of little clinical benefit.
  • Chronic pericardial effusion
    • Effusions lasting longer than 6 months.
    • Usually well tolerated.

Prognosis

  • Most patients with acute pericarditis recover without sequelae. Predictors of a worse outcome include the following: fever greater than 38°C, symptoms developing over several weeks in association with immunosuppressed state, traumatic pericarditis, pericarditis in a patient receiving oral anticoagulants, a large pericardial effusion (>20 mm echo-free space or evidence of tamponade), or failure to respond to NSAIDs. In a recent series of 300 patients with acute pericarditis, 254 (85%) did not have any of the high-risk characteristics and had no serious complications. Of these low-risk patients, 221 (87%) were managed as outpatients and the other 13% were hospitalized when they did not respond to aspirin.
  • Patients with symptomatic pericardial effusions from HIV/AIDS or cancer have high short-term mortality rates.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider pericardial effusion as a principal or secondary diagnosis may lead to rapid deterioration and death secondary to cardiac tamponade.
  • Patients with viral cardiomyopathy, especially in the acute setting, may have a similar presentation, with an enlarged heart on chest radiographs. Echocardiography readily distinguishes the difference between enlarged cardiac chambers and a pericardial effusion.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Susan Noe, MD to the development and writing of this article.



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References
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Further Reading

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Keywords

pericardial effusion, pericardial sac, dropsy of pericardium, pericarditis, pericardial tamponade, pericardiocentesis, pericardioscopy, malignant pericardial effusion, leukemia, lymphoma, idiopathic effusions, Beck triad of pericardial tamponade, hypotension, muffled heart sounds, jugular venous distension

pulsus paradoxus, pericardial friction rub, hepatojugular reflux, Ewart sign, hepatosplenomegaly, cyanosis, hydropericardium, congestive heart failure, valvular disease, mediastinal lymphoma, Hodgkin disease, metastatic breast cancer, bacterial pericardial effusion, viral pericardial effusion, tuberculous pericardial effusion, parasitic pericardial effusion, HIV-related pericardial effusion, fungal pericardial effusion, systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, vasculitides, uremia, postpericardiotomy syndrome, chylopericardium, myxedema, radiation-induced pericardial effusion

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Contributor Information and Disclosures

Author

William J Strimel, DO, Fellow, Cardiovascular Disease, Scott and White Memorial Hospital
William J Strimel, DO is a member of the following medical societies: American College of Cardiology, American College of Physicians, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Ramin Assadi, MD, Staff Physician, Department of Internal Medicine, Loma Linda University
Ramin Assadi, MD is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Ali A Sovari, MD, Research Fellow, Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles (UCLA)
Ali A Sovari, MD is a member of the following medical societies: American College of Physicians, American Heart Association, and American Medical Association
Disclosure: Nothing to disclose.

Abraham G Kocheril, MD, FACC, FACP, Professor of Medicine, Director of Clinical Electrophysiology, University of Illinois at Chicago
Abraham G Kocheril, MD, FACC, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Cardiac Electrophysiology Society, Central Society for Clinical Research, Heart Failure Society of America, Heart Rhythm Society, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Justin D Pearlman, MD, PhD, ME, MA, Director of Dartmouth Advanced Imaging Center, Professor of Medicine, Professor of Radiology, Adjunct Professor, Thayer Bioengineering and Computer Science, Dartmouth-Hitchcock Medical Center
Justin D Pearlman, MD, PhD, ME, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald J Oudiz, MD, Director of Pulmonary Hypertension, Associate Professor, Department of Medicine, Division of Cardiology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA
Ronald J Oudiz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association
Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

George A Stouffer III, MD, Henry A Foscue Distinguished Professor of Medicine and Cardiology, Director of Interventional Cardiology, Cardiac Catheterization Laboratory, Chief of Clinical Cardiology, Division of Cardiology, University of North Carolina Medical Center
George A Stouffer III, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, Phi Beta Kappa, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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