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.
Hospitalization
Admission into the Intensive Care Unit (ICU) is indicated for emergency management of pericardial effusion associated with significant symptoms and cardiac tamponade.
Initial Resuscitation
Hemodynamic Monitoring
Pharmacological Therapy
Management of the underlying cause of pericardial effusion is crucial. Medications can be used to manage nonsevere cases of pericardial effusion, including:
They are effective for the management of pericardial effusion due to idiopathic or viral infections.
0.5mg PO BID for 3-6months
It can be used for the management of pericardial effusion due to inflammatory causes.
They may be considered for the management of recurrent cases related to inflammatory causes that are not adequately responsive to NSAIDs and colchicine.
They are indicated for the management of pericardial effusions related to bacterial infections.
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.
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.
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.
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.
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.
It is a surgical procedure that is done under general anesthesia to allow better visualization of the pericardium.
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.
It is a surgical procedure that is considered to prevent recurrent cardiac tamponade and pericardial effusion related to malignant etiology.
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