Pericardial Effusion- Management

Approach Considerations

Pharmacotherapy for pericardial effusion includes use of the following agents, depending on etiology:

Aspirin/NSAIDs

Colchicine

Steroids

Antibiotics

Antineoplastic therapy (eg, systemic chemotherapy, radiation) in conjunction with pericardiocentesis has been shown to be effective in reducing recurrences of malignant effusions. Corticosteroids and NSAIDs are helpful in patients with autoimmune conditions.

Pericardial sclerosis

Several pericardial sclerosing agents have been used with varying success rates (eg, tetracycline, doxycycline, cisplatin, 5-fluorouracil). The pericardial catheter may be left in place for repeat instillation if necessary until the effusion resolves.

Complications include intense pain, atrial dysrhythmias, fever, and infection. Success rates are reported to be as high as 91% at 30 days.

Surgery

Surgical treatments for pericardial effusion include the following:

Pericardiostomy

Pericardotomy

Thoracotomy

Sternotomy

Pericardiocentesis

Inpatient care

Patients with pericardial effusion who present with significant symptoms or cardiac tamponade require emergent treatment and admission to the intensive care unit (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

Outpatient care

Patients should be educated with regard to 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.

Consultations

A cardiologist should be involved in the care of patients with pericardial effusion. Cardiothoracic surgery may be required for recurrent or complicated cases.