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., Abdelrahman Ibrahim Abushouk, MD[2]

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, or purulent effusion and rarely occurs in idiopathic pericardial effusion.
• Various complications depend on the etiology of the disease:
  • 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 prognosiswith few developing recurrences.
  • Tuberculous Cause
    • The mortality rate associated with tuberculous pericardial disease in the preantibiotic era was 80-90%. The mortality rate is currently 8-17%. The mortality is 17-34% if the tuberculous pericardial effusion is associated with HIV.
  • 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.

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.