Pericardial Effusion Medication

  • Author: William J Strimel, DO; Chief Editor: Joseph L Fredi, MD   more...
 
Updated: Jun 30, 2010
 

Medication Summary

Autoimmune pericardial effusions may respond to treatment with anti-inflammatory medications. In general, selection of an agent depends on the severity of the patient's symptoms and the tolerability and adverse effect profiles of the medications.

Next

Nonsteroidal anti-inflammatory drugs

Class Summary

Are used mostly for patients with active, nonhemorrhagic pericarditis with or without pericardial effusion. NSAIDS have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action in pericarditis is not known, but NSAIDS may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.

View full drug information

Indomethacin (Indocin, Indometh)

 

Drug of choice in this class, although other NSAIDs (ie, ibuprofen, naproxen, aspirin) possess some efficacy. Used as initial therapy for mild-to–moderately severe inflammatory pericardial effusions.

Previous
Next

Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

View full drug information

Prednisone (Deltasone, Orasone, Sterapred)

 

Used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed. Other agents may be used if adverse effect profile warrants; dosages should be determined by prednisone equivalents.

Previous
Next

Anti-inflammatory Agent

Class Summary

These agents inhibit key factors involved in inflammatory reactions.

View full drug information

Colchicine

 

Alkaloid extract that inhibits microtubule formation. Has unique anti-inflammatory properties. Concentrates well in leukocytes and reduces neutrophilic chemotaxis and motility. Reduces release of lactic acid and proinflammatory enzymes. Inhibits release of histamine-containing granules from mast cells, which may be important in pathogenesis of elastic tissue changes found in anetoderma.

Use in autoimmune disease is primarily empiric, and mechanism of action in decreasing inflammation is not clear, nor is it truly an immunomodulating agent.

Previous
Proceed to Follow-up
 
 
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 Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ramin Assadi, MD  Senior Fellow, Department of Cardiology, Loma Linda University School of Medicine

Ramin Assadi, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Ali A Sovari, MD, FACP  Clinical and Research Fellow in Cardiovascular Medicine, Section of Cardiology, University of Illinois College of Medicine; Staff Physician and Hospitalist, St John Regional Medical Center, Cogent Healthcare, Inc

Ali A Sovari, MD, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Physiological Society, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Abraham G Kocheril, MD, FACC, FACP, FHRS  Professor of Medicine, University of Illinois College of Medicine

Abraham G Kocheril, MD, FACC, FACP, FHRS 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, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Justin D Pearlman, MD, PhD, ME, MA  Director of Advanced Cardiovascular Imaging, 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald J Oudiz, MD, FACP, FACC, FCCP  Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

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; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting

Amer Suleman, MD  Private Practice

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

Joseph L Fredi, MD  Assistant Professor of Medicine, Director of Acute MI Program, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center

Joseph L Fredi, MD is a member of the following medical societies: American College of Cardiology and American College of Physicians

Disclosure: Nothing to disclose.

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.

References

  1. Montaudon M, Roubertie F, Bire F, Laurent F. Congenital pericardial defect: report of two cases and literature review. Surg Radiol Anat. Apr 2007;29(3):195-200. [Medline].

  2. Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. Jan 2007;60(1):27-34. [Medline].

  3. Meenakshisundaram R, Sweni S, Thirumalaikolundusubramanian P. Cardiac isoform of alpha 2 macroglobulin: a marker of cardiac involvement in pediatric HIV and AIDS. Pediatr Cardiol. Nov 14 2009;[Medline].

  4. Natanzon A, Kronzon I. Pericardial and pleural effusions in congestive heart failure-anatomical, pathophysiologic, and clinical considerations. Am J Med Sci. Sep 2009;338(3):211-6. [Medline].

  5. Kuvin JT, Harati NA, Pandian NG, Bojar RM, Khabbaz KR. Postoperative cardiac tamponade in the modern surgical era. Ann Thorac Surg. Oct 2002;74(4):1148-53. [Medline].

  6. Tsang TS, Barnes ME, Hayes SN, Freeman WK, Dearani JA, Butler SL, et al. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo-guided pericardiocentesis for management: Mayo Clinic experience, 1979-1998. Chest. Aug 1999;116(2):322-31. [Medline].

  7. Ciliberto GR, Anjos MC, Gronda E, Bonacina E, Danzi G, Colombo P, et al. Significance of pericardial effusion after heart transplantation. Am J Cardiol. Aug 1 1995;76(4):297-300. [Medline].

  8. Rosenbaum E, Krebs E, Cohen M, et al. The spectrum of clinical manifestations, outcome and treatment of pericardial tamponade in patients with systemic lupus erythematosus: a retrospective study and literature review. Lupus. Jun 2009;18(7):608-12. [Medline].

  9. Hoit BD. Pericardial disease and pericardial tamponade. Crit Care Med. Aug 2007;35(8 Suppl):S355-64. [Medline].

  10. Karia DH, Xing YQ, Kuvin JT, Nesser HJ, Pandian NG. Recent role of imaging in the diagnosis of pericardial disease. Curr Cardiol Rep. Jan 2002;4(1):33-40. [Medline].

  11. Horowitz MS, Schultz CS, Stinson EB. Sensitivity and specificityof echocardiographic diagnosis of pericardial effusion. Circulation. 1974;50:239-47.

  12. Taguchi R, Takasu J, Itani Y, Yamamoto R, Yokoyama K, Watanabe S, et al. Pericardial fat accumulation in men as a risk factor for coronary artery disease. Atherosclerosis. Jul 2001;157(1):203-9. [Medline].

  13. Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab. Nov 2005;90(11):6300-2. [Medline].

  14. Palmer SL, Kelly PD, Schenkel FA, Barr ML. CT-guided tube pericardiostomy: a safe and effective technique in the management of postsurgical pericardial effusion. Am J Roentgenol. OCT 2009;193:W314-20. [Medline].

  15. Meurin P, Tabet JY, Thabut G, Cristofini P, Farrokhi T, Fischbach M, et al. Nonsteroidal anti-inflammatory drug treatment for postoperative pericardial effusion: a multicenter randomized, double-blind trial. Ann Intern Med. Feb 2 2010;152(3):137-43. [Medline].

  16. Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation. Sep 27 2005;112(13):2012-6. [Medline].

  17. Motas C, Motas N, Rus O, et al. Left paraxiphoidian approach for drainage of pericardial effusions. Interact Cardiovasc Thorac Surg. Sep 15 2009;[Medline]. [Full Text].

  18. Palma JH, Gaia DF, Guilhen JC, et al. Video-thoracoscopic pericardial drainage in the treatment of pericardial effusions. Rev Bras Cir Cardiovasc. Mar 2009;24(1):44-9. [Medline]. [Full Text].

  19. Allen KB, Faber LP, Warren WH. Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage. Ann Thorac Surg. Feb 1999;67(2):437-40. [Medline].

  20. Artom G, Koren-Morag N, Spodick DH, Brucato A, Guindo J, Bayes-de-Luna A, et al. Pretreatment with corticosteroids attenuates the efficacy of colchicine in preventing recurrent pericarditis: a multi-centre all-case analysis. Eur Heart J. Apr 2005;26(7):723-7. [Medline].

  21. Barbaro G. Cardiovascular manifestations of HIV infection. Circulation. Sep 10 2002;106(11):1420-5. [Medline].

  22. Moore KL, Persaud TVN. Before We Are Born: Essentials of Embryology and Birth Defects. 4th ed. 1993.

  23. Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P. Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur Heart J. May 2000;21(10):832-6. [Medline].

  24. Braunwald E. Cardiology: how did we get here, where are we today and where are we going?. Can J Cardiol. Oct 2005;21(12):1015-7. [Medline].

  25. Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia: WB Saunders Company; 1997:1478-96.

  26. Cheitlin MD, Alpert JS, Armstrong WF. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in coll. Circulation. Mar 18 1997;95(6):1686-744. [Medline].

  27. Chen Y, Brennessel D, Walters J. Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature. Am Heart J. Mar 1999;137(3):516-21. [Medline].

  28. Chong HH, Plotnick GD. Pericardial effusion and tamponade: evaluation, imaging modalities, and management. Compr Ther. Jul 1995;21(7):378-85. [Medline].

  29. Eisenberg MJ, de Romeral LM, Heidenreich PA. The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment. Chest. Aug 1996;110(2):318-24. [Medline].

  30. Fagan SM, Chan KL. Pericardiocentesis: blind no more! [editorial; comment]. Chest. Aug 1999;116(2):275-6. [Medline].

  31. Feigenbaum, H. Echocardiography. 1994. 5th ed. Philadelphia: Lea & Febiger; 556-74.

  32. Flores RM, Jaklitsch MT, DeCamp MM Jr. Video-assisted thoracic surgery pericardial resection for effusive disease. Chest Surg Clin N Am. Nov 1998;8(4):835-51. [Medline].

  33. Guberman BA, Fowler NO, Engel PJ. Cardiac tamponade in medical patients. Circulation. Sep 1981;64(3):633-40. [Medline].

  34. Heidenreich PA, Eisenberg MJ, Kee LL. Pericardial effusion in AIDS. Incidence and survival. Circulation. Dec 1 1995;92(11):3229-34. [Medline].

  35. Ilan Y, Oren R, Ben-Chetrit E. Etiology, treatment, and prognosis of large pericardial effusions. A study of 34 patients. Chest. Oct 1991;100(4):985-7. [Medline].

  36. Imazio M, Demichelis B, Cecchi E, et al. Cardiac troponin I in acute pericarditis. J Am Coll Cardiol. Dec 17 2003;42(12):2144-8. [Medline].

  37. Imazio M, Demichelis B, Parrini I, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol. Mar 17 2004;43(6):1042-6. [Medline].

  38. Kasper D, Branunwald E, Fauci A, et al. Harrison's Principles of Internal Medicine. 16th ed. McGraw-Hill Professional; 2005:1414-1420.

  39. Kimberly RP. Treatment. Corticosteroids and anti-inflammatory drugs. Rheum Dis Clin North Am. Apr 1988;14(1):203-21. [Medline].

  40. Kocheril AG, Luttmann C, Sadaniantz A. Pneumococcal pericarditis successfully treated with catheter drainage and intravenous antibiotics. Cathet Cardiovasc Diagn. Dec 1991;24(4):286-7. [Medline].

  41. Lange RA, Hillis LD. Clinical practice. Acute pericarditis. N Engl J Med. Nov 18 2004;351(21):2195-202. [Medline].

  42. Little WC, Freeman GL. Pericardial disease. Circulation. Mar 28 2006;113(12):1622-32. [Medline].

  43. Maher EA, Shepherd FA, Todd TJ. Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade. J Thorac Cardiovasc Surg. Sep 1996;112(3):637-43. [Medline].

  44. Maisch B. Pericardial diseases, with a focus on etiology, pathogenesis, pathophysiology, new diagnostic imaging methods, and treatment. Curr Opin Cardiol. May 1994;9(3):379-88. [Medline].

  45. Maisch B, Ristic AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy. Eur Heart J. Oct 2002;23(19):1503-8. [Medline].

  46. Mangan CM. Malignant pericardial effusions: pathophysiology and clinical correlates. Oncol Nurs Forum. Sep 1992;19(8):1215-21. [Medline].

  47. Maruyama R, Yokoyama H, Seto T, Nagashima S, Kashiwabara K, Araki J, et al. Catheter drainage followed by the instillation of bleomycin to manage malignant pericardial effusion in non-small cell lung cancer: a multi-institutional phase II trial. J Thorac Oncol. Jan 2007;2(1):65-8. [Medline].

  48. Mayosi BM, Burgess LJ, Doubell AF. Tuberculous pericarditis. Circulation. Dec 6 2005;112(23):3608-16. [Medline].

  49. Mercé J, Sagristà-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J. Oct 1999;138(4 Pt 1):759-64. [Medline].

  50. Meyers DG, Bagin RG, Levene JF. Electrocardiographic changes in pericardial effusion. Chest. Nov 1993;104(5):1422-6. [Medline].

  51. Meyers DG, Meyers RE, Prendergast TW. The usefulness of diagnostic tests on pericardial fluid. Chest. May 1997;111(5):1213-21. [Medline].

  52. Naqvi TZ, Huynh HK. A new window of opportunity in echocardiography. J Am Soc Echocardiogr. May 2006;19(5):569-77. [Medline].

  53. Nugue O, Millaire A, Porte H. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. Circulation. Oct 1 1996;94(7):1635-41. [Medline].

  54. Pankuweit S, Ristic AD, Seferovic PM, Maisch B. Bacterial pericarditis: diagnosis and management. Am J Cardiovasc Drugs. 2005;5(2):103-12. [Medline].

  55. Press OW, Livingston R. Management of malignant pericardial effusion and tamponade. JAMA. Feb 27 1987;257(8):1088-92. [Medline].

  56. Retter AS. Pericardial disease in the oncology patient. Heart Dis. Nov-Dec 2002;4(6):387-91. [Medline].

  57. Sagrista-Sauleda J, Angel J, Permanyer-Miralda G. Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med. Dec 30 1999;341(27):2054-9. [Medline].

  58. Shabetai R. Recurrent pericarditis: recent advances and remaining questions. Circulation. Sep 27 2005;112(13):1921-3. [Medline].

  59. Silva-Cardoso J, Moura B, Martins L. Pericardial involvement in human immunodeficiency virus infection. Chest. Feb 1999;115(2):418-22. [Medline].

  60. Spodick DH. Acute pericarditis: current concepts and practice. JAMA. Mar 5 2003;289(9):1150-3. [Medline].

  61. Spodick DH. Intrapericardial treatment of persistent autoreactive pericarditis/myopericarditis and pericardial effusion. Eur Heart J. Oct 2002;23(19):1481-2. [Medline].

  62. Spodick DH. The technique of pericardiocentesis. When to perform it and how to minimize complications. J Crit Illn. Nov 1995;10(11):807-12. [Medline].

  63. Vaitkus PT, Herrmann HC, LeWinter MM. Treatment of malignant pericardial effusion. JAMA. Jul 6 1994;272(1):59-64. [Medline].

  64. Weisse AB, Desai RR, Rajihah G. Contrast echocardiography as an adjunct in hemorrhagic or complicated pericardiocentesis. Am Heart J. Apr 1996;131(4):822-5. [Medline].

  65. Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC. The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study. Circulation. Mar 1984;69(3):506-11. [Medline].

  66. Zhang P, Liegeois NJ, Wong C, et al. Altered cell differentiation and proliferation in mice lacking p57KIP2 indicates a role in Beckwith-Wiedemann syndrome. Nature. May 8 1997;387(6629):151-8. [Medline].

 
Previous
Next
 
Image is from a patient with malignant pericardial effusion. Note the "water-bottle" appearance of the cardiac silhouette in the anteroposterior (AP) chest film.
Echocardiogram (parasternal, long axis) of a patient with a moderate pericardial effusion.
This image is from a patient with malignant pericardial effusion. The effusion is seen as an echo-free region to the right of the left ventricle (LV).
This electrocardiogram (ECG) is from a patient with malignant pericardial effusion. The ECG shows diffuse low voltage, with a suggestion of electrical alternans in the precordial leads.
Subcostal view of an echocardiogram that shows a moderate-to-large amount of pericardial effusion.
This echocardiogram shows a large amount of pericardial effusion (identified by the white arrows).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.