Pericardial Effusion and Cardiac Tamponade Management

Pericardial Effusion and Cardiac Tamponade Management

Pericardial Effusion and Cardiac Tamponade Management

Dec 6, 2023

Pericardial effusion is a medical condition where transudate or exudate fluid is accumulated in the pericardial cavity around the heart, exceeding 50 ml, as a result of infectious or non-infectious causes such as myocardial infarction, kidney failure, autoimmune disorders, and malignancies.

Cardiac tamponade is a medical emergency condition that is developed due to severe pericardial effusion, which elevates intrapericardial pressure and impedes ventricle relaxation and filling. As a result, cardiac output will be reduced, which could lead to hemodynamic instability and elevated mortality risk. 


Admission into the Intensive Care Unit (ICU) is indicated for emergency management of pericardial effusion associated with significant symptoms and cardiac tamponade. 

Initial Resuscitation

  • Intravenous fluids and intravenous medications with positive ionotropic effects are indicated to be used to stabilize hemodynamically unstable patients.
  • Oxygen therapy is indicated for cardiac tamponade patients. However, positive-pressure mechanical ventilation must be avoided as it may exacerbate the drop in cardiac output.
  • Staying in bed with leg elevation is recommended for cardiac tamponade patients due to elevated venous return and subsequent cardiac output.

Hemodynamic Monitoring 

  • A pulmonary artery catheter (Swan-Ganz catheter) is indicated to be placed if cardiac tamponade is diagnosed or if there is a high risk of developing It is used to access hemodynamic parameters, access effusion reaccumulation, and detect constructive disease after pericardiocentesis. 
  • Chest radiography must be performed and repeated to evaluate pericardial effusion and monitor the efficacy of management. 

Pharmacological Therapy

Management of the underlying cause of pericardial effusion is crucial. Medications can be used to manage nonsevere cases of pericardial effusion, including:

  • Non-steroidal anti-inflammatory Drugs (NSAIDs) 
  • Aspirin 750-1000mg PO TID for 1-2weeks
  • Ibuprofen 600mg PO TID for 1-2weeks 
  • Diclofenac is not effective 

They are effective for the management of pericardial effusion due to idiopathic or viral infections.

  • Colchicine

0.5mg PO BID for 3-6months 

It can be used for the management of pericardial effusion due to inflammatory causes. 

  • Corticosteroids
  • Prednisolone 0.5mg/kg/day for 2-4weeks

They may be considered for the management of recurrent cases related to inflammatory causes that are not adequately responsive to NSAIDs and colchicine.

  • Antibiotics

They are indicated for the management of pericardial effusions related to bacterial infections. 

  • Pericardium Sclerosing

The intrapericardial administration of corticosteroids, tetracycline, or antineoplastic drugs through an inserted catheter may be considered in recurrent cases.

Pericardium Fluid Drainage

It is indicated in the case of cardiac tamponade, moderate to severe pericardial effusion, and pericardial effusion with a high recurrence risk that is associated with malignancy or purulent pericarditis. As a result, anticoagulant administration must be held before the drainage procedure.

  • Pericardiocentesis (Pericardial Tap)

It is a procedure that is done by inserting a needle and 16 gauge catheter percutaneously in the substernal, parasternal, or apical region into the pericardial cavity for pericardial fluid drainage. It is performed under local anesthesia and with the guidance of an echocardiogram and electrocardiography to avoid myocardial injury. In addition, the drained fluid can be analyzed.

  • Percutaneous Balloon Pericardiotomy

It is a procedure where a catheter tube is inserted percutaneously under local anesthesia using fluoroscopy guidance into the pericardial cavity, which is inflated by a balloon to drain pericardial fluid. 

  • CT guided Pericardiostomy

It is a surgical procedure that is done under the guidance of computed tomography to drain pericardial fluid when percutaneous procedures are difficult to perform due to factors such as postoperative state, obesity, and chronic obstructive pulmonary disease.

  • Subxiphoid Pericardiotomy window

It is indicated to manage pericardial effusion in hemodynamically unstable patients. Where an incision is made above the xiphoid process, which is resected after that, then the underneath pericardium can be drained by creating a window. 

  • Surgical Thoracotomy

It is a surgical procedure that is done under general anesthesia to allow better visualization of the pericardium.

  • Surgical Pericardiectomy

It is a surgical procedure that is performed through a median sternotomy or left thoracotomy to cut off the pericardium. It may be considered to manage recurrent pleural effusion or cardiac Tamponade, or when pericardial effusion is related to constrictive pericarditis.

  • Pericardio-Peritoneal Shunt

It is a surgical procedure that is considered to prevent recurrent cardiac tamponade and pericardial effusion related to malignant etiology.




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