eMedicine Specialties > Emergency Medicine > Cardiovascular

Pericarditis and Cardiac Tamponade: Follow-up

Author: Verena T Valley, MD, Associate Professor, Director of Ultrasound, Department of Emergency Medicine, University of Mississippi School of Medicine; Consulting Staff, Department of Emergency Medicine, Singing River Hospital System, Singing River Hospital, and Ocean Springs Hospital
Coauthor(s): Christopher A Fly, MD, Assistant Professor, Department of Emergency Medicine, Medical College of Georgia
Contributor Information and Disclosures

Updated: May 12, 2008

Follow-up

Complications

  • Pericarditis may recur in 15-32% of patients.
  • Noncompressive effusion may occur.
  • Chronic constrictive pericarditis is a potential complication.
  • Cardiac perforation may occur at time of pericardiocentesis.
  • Bronchopericardial fistula was noted as a complication of multi–drug-resistant tuberculosis in a patient with HIV.6
  • Liver disease has been reported in asymptomatic constrictive pericarditis.

Prognosis

  • The prognosis for patients with pericarditis depends on the etiology of the pericardial infection or inflammation as well as the presence of a pericardial effusion and/or tamponade.
    • Acquired immunodeficiency syndrome: Small asymptomatic pericardial effusions may not require diagnostic evaluation.7 Large symptomatic pericardial effusions should be investigated because two thirds of such effusions are potentially infections or neoplasms. Tuberculous pericarditis can occur. Adjunctive prednisolone may reduce mortality in this population.
    • Postmyocardial infarction pericarditis: This may occur in approximately 5% of patients receiving thrombolytic drugs. Dressler syndrome is now considered rare. Most postmyocardial infarction cases have a benign course; however, pericarditis is associated with larger infarcts. Therefore, overall long-term mortality may be increased.
    • Chronic idiopathic pericarditis: This is defined as a pericardial effusion that persists more than 3 months without any apparent etiology. Pericardiocentesis alone results in resolution of large effusions; however, recurrence is common. Pericardiectomy should be considered in recurrent cases because it yields good long-term effects. High-dose prednisone may prevent recurrent pericarditis resistant to NSAIDs.
  • Cardiac tamponade
    • For penetrating injuries, the prognosis depends heavily on the rapid identification of tamponade.
    • Favorable factors include minor perforations, isolated right ventricular wounds, systolic blood pressure more than 50 mm Hg, and presence of tamponade.

Miscellaneous

Medicolegal Pitfalls

  • Be careful not to confuse this disease entity with esophageal disorders, costochondritis, or other causes of noncardiac chest pain.
  • The potential misdiagnosis of pericarditis for AMI has led to unfortunate complications when thrombolytic therapy has been given.
  • Tension pneumothorax may mimic cardiac tamponade. Trauma ultrasonography has limited this misdiagnosis.
  • Elevated CVP may be absent in patients with preexisting hypovolemia.
  • Rarely, air can enter the pericardium and obscure the sonographic evaluation.
 


More on Pericarditis and Cardiac Tamponade

Overview: Pericarditis and Cardiac Tamponade
Differential Diagnoses & Workup: Pericarditis and Cardiac Tamponade
Treatment & Medication: Pericarditis and Cardiac Tamponade
Follow-up: Pericarditis and Cardiac Tamponade
Multimedia: Pericarditis and Cardiac Tamponade
References
[ CLOSE WINDOW ]

References

  1. Merce J, Sagrista Sauleda J, Permanyer Miralda G. [Pericardial effusion in the elderly: A different disease?]. Rev Esp Cardiol. Nov 2000;53(11):1432-6. [Medline].

  2. Chraibi S, Ibnabdeljalil H, Habbal R, et al. Pericardial tamponade as the first manifestation of dermatopolymyositis. Ann Med Interne (Paris). Nov 1998;149(7):464-6. [Medline].

  3. Adler Y, Finkelstein Y, Guindo J. Colchicine treatment for recurrent pericarditis. A decade of experience. Circulation. Jun 2 1998;97(21):2183-5. [Medline].

  4. Adler Y, Guindo J, Finkelstein Y. Colchicine for large pericardial effusion. Clin Cardiol. Feb 1998;21(2):143-4. [Medline].

  5. Iyoda M, Ajiro Y, Sato K. A case of refractory uremic pleuropericarditis--successful corticosteroid treatment. Clin Nephrol. Apr 2006;65(4):290-3. [Medline].

  6. Bennett JA, Haramati LB. CT of bronchopericardial fistula: an unusual complication of multidrug- resistant tuberculosis in HIV infection. AJR Am J Roentgenol. Sep 2000;175(3):819-20. [Medline].

  7. Estok L, Wallach F. Cardiac tamponade in a patient with AIDS: a review of pericardial disease in patients with HIV infection. Mt Sinai J Med. Jan 1998;65(1):33-9. [Medline].

  8. Aikat S, Ghaffari S. A review of pericardial diseases: clinical, ECG and hemodynamic features and management. Cleve Clin J Med. Dec 2000;67(12):903-14. [Medline].

  9. Antony SJ, Haas DW. Tuberculous pericarditis in an HIV-infected patient. Scand J Infect Dis. 1995;27(4):411-3. [Medline].

  10. Atwood JE, Osterberg L. Images in clinical medicine. Constrictive pericarditis. N Engl J Med. Jul 13 2000;343(2):106. [Medline].

  11. Barbaro G, Fisher SD, Giancaspro G. HIV-associated cardiovascular complications: a new challenge for emergency physicians. Am J Emerg Med. Nov 2001;19(7):566-74. [Medline].

  12. Breen JF. Imaging of the pericardium. J Thorac Imaging. Jan 2001;16(1):47-54. [Medline].

  13. De Benedetti E, Didier D. Images in clinical medicine. Constrictive pericarditis. N Engl J Med. Jul 13 2000;343(2):107. [Medline].

  14. Debehnke DJ. Cardiac-related acute infectious disease. In: Emergency Cardiac Care. ed. 1994:463-88.

  15. Donnelly LF, Kimball TR, Barr LL. Purulent pericarditis presenting as acute abdomen in children: abdominal imaging findings. Clin Radiol. Oct 1999;54(10):691-3. [Medline].

  16. Gibbs CR, Watson RD, Singh SP, Lip GY. Management of pericardial effusion by drainage: a survey of 10 years' experience in a city centre general hospital serving a multiracial population. Postgrad Med J. Dec 2000;76(902):809-13. [Medline].

  17. Goldstein JA. Cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy. Curr Probl Cardiol. Sep 2004;29(9):503-67. [Medline].

  18. Gupta R, Munyak J, Haydock T. Hypothyroidism presenting as acute cardiac tamponade with viral pericarditis. Am J Emerg Med. Mar 1999;17(2):176-8. [Medline].

  19. Hakim JG, Ternouth I, Mushangi E. Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients. Heart. Aug 2000;84(2):183-8. [Medline].

  20. Hauser AM. The emerging role of echocardiography in the emergency department. Ann Emerg Med. 1989;18:1298-1303. [Medline].

  21. Horowitz MS, Schultz CS, Stinson EB. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation. Aug 1974;50(2):239-47. [Medline].

  22. Humphreys M. Pericardial conditions: signs, symptoms and electrocardiogram changes. Emerg Nurse. Apr 2006;14(1):30-6. [Medline].

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

  24. Indik JH, Alpert JS. Post-Myocardial Infarction Pericarditis. Curr Treat Options Cardiovasc Med. Aug 2000;2(4):351-356. [Medline].

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

  26. Keefe DL. Cardiovascular emergencies in the cancer patient. Semin Oncol. Jun 2000;27(3):244-55. [Medline].

  27. Marcolongo R, Russo R, Laveder F. Immunosuppressive therapy prevents recurrent pericarditis. J Am Coll Cardiol. Nov 1 1995;26(5):1276-9. [Medline].

  28. Markovchick V, Duffens KR. Cardiovascular trauma. In: Rosen P, Barkin RM, et al, eds. Emergency Medicine Concepts and Clinical Practice. 3rd ed. 1992:439-59. [Medline].

  29. Mastroianni A, Coronado O, Chiodo F. Tuberculous pericarditis and AIDS: case reports and review. Eur J Epidemiol. Oct 1997;13(7):755-9. [Medline].

  30. Mayron R, Gaudio FE, Plummer D. Echocardiography performed by emergency physicians: impact on diagnosis and therapy. Ann Emerg Med. Feb 1988;17(2):150-4. [Medline].

  31. Palacios IF. Pericardial Effusion and Tamponade. Curr Treat Options Cardiovasc Med. Jun 1999;1(1):79-89. [Medline].

  32. Plummer D, Dick C, Ruiz E. Emergency department two-dimensional echocardiography in the diagnosis of nontraumatic cardiac rupture. Ann Emerg Med. Jun 1994;23(6):1333-42. [Medline].

  33. Ristic AD, Seferovic PM, Ljubic A. Pericardial disease in pregnancy. Herz. May 2003;28(3):209-15. [Medline].

  34. Sagrista Sauleda J, Almenar Bonet L, Angel Ferrer J. [The clinical practice guidelines of the Sociedad Espanola de Cardiologia on pericardial pathology]. Rev Esp Cardiol. Mar 2000;53(3):394-412. [Medline].

  35. 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].

  36. Sagrista-Sauleda J, Merce J, Permanyer-Miralda G. Clinical clues to the causes of large pericardial effusions. Am J Med. Aug 1 2000;109(2):95-101. [Medline].

  37. Salem K, Mulji A, Lonn E. Echocardiographically guided pericardiocentesis - the gold standard for the management of pericardial effusion and cardiac tamponade. Can J Cardiol. Nov 1999;15(11):1251-5. [Medline].

  38. Sechtem U, Tscholakoff D, Higgins CB. MRI of the abnormal pericardium. AJR Am J Roentgenol. Aug 1986;147(2):245-52. [Medline].

  39. Sheth AA, Lim JK. Liver Disease From Asymptomatic Constrictive Pericarditis. J Clin Gastroenterol. Apr 1 2008;[Medline].

  40. Shikama N, Terano T, Hirai A. A case of rheumatoid pericarditis with high concentrations of interleukin-6 in pericardial fluid. Heart. Jun 2000;83(6):711-2. [Medline].

  41. Spodick DH. Differential diagnosis of acute pericarditis. Prog Cardiovasc Dis. 1971;14:192. [Medline].

  42. Spodick DH. Pericarditis, pericardial effusion, cardiac tamponade and constriction. Crit Care Clin. 1989;5:455. [Medline].

  43. Tsai MS, Yang CW, Chi CL. Acute pericarditis: a rare complication of Graves' thyrotoxicosis?. Am J Emerg Med. May 2006;24(3):374-5. [Medline].

  44. Tsang TS, Freeman WK, Sinak LJ. Echocardiographically guided pericardiocentesis: evolution and state-of- the-art technique. Mayo Clin Proc. Jul 1998;73(7):647-52. [Medline].

  45. Vasquez A, Butman SM. Pathophysiologic mechanisms in pericardial disease. Curr Cardiol Rep. Jan 2002;4(1):26-32. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

pericardium, pericardial complex, acute pericardial tamponade, pericardial effusion, malignancy, tuberculous pericarditis, precordial chest pain, retrosternal chest pain, end-stage renal disease, ESRD, traumatic tamponade, decompressing tamponade, pericardial friction rub, premature atrial contractions, premature ventricular contractions, cardiac arrhythmias, tachypnea, dyspnea, myocarditis, Ewart sign, hepatomegaly, ascites, Beck triad, jugular venous distention, hypotension, muffled heart sounds, pulsus paradoxus, cyanosis, serous pericarditis, rheumatoid arthritis, RA, systemic lupus erythematosus, SLE, fibrous pericarditis, serofibrinous pericarditis, acute myocardial infarction, AMI, Dressler syndrome, uremia, radiation, suppurative pericarditis, purulent pericarditis, cardiotomy, constrictive pericarditis, hemorrhagic pericarditis, bleeding diathesis, caseous pericarditis, adhesive mediastinopericarditis, concretio cordis, malignant pericarditis, penetrating cardiac injuries, hemopericardium, pericardial hematoma, pacemaker insertion, cardiac catheterization, sternal bone marrow biopsies, pericardiocentesis, dermatopolymyositis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Verena T Valley, MD, Associate Professor, Director of Ultrasound, Department of Emergency Medicine, University of Mississippi School of Medicine; Consulting Staff, Department of Emergency Medicine, Singing River Hospital System, Singing River Hospital, and Ocean Springs Hospital
Verena T Valley, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Christopher A Fly, MD, Assistant Professor, Department of Emergency Medicine, Medical College of Georgia
Christopher A Fly, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

David A Peak, MD, Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary
David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Eric Legome, MD, Residency Director, Assistant Professor of Emergency Medicine, Department of Emergency Medicine New York University, New York University Hospital, Bellevue Hospital Center, Manhattan VA
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Charles V Pollack, Jr, MD, MA, FACEP, Professor, Department of Emergency Medicine, University of Pennsylvania College of Medicine; Chairman, Department of Emergency Medicine, Pennsylvania Hospital
Charles V Pollack, Jr, MD, MA, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: sanofi-aventis Honoraria Consulting; sanofi-aventis Honoraria Speaking and teaching; Schering-Polugh Honoraria Consulting; Schering-Plough Honoraria Speaking and teaching; The Medicines Company Honoraria Consulting; GlaxoSmithKline Grant/research funds Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.