Pericardial effusion is the abnormal accumulation of fluid in the pericardial space. Cholesterol pericarditis is a rare disorder that may be associated with myxedema, in which a chronic pericardial effusion has a high level of cholesterol that triggers inflammation and pericarditis. Coauthored by dermot phelan, patrick collier and richard grimm of the cleveland clinic. Download pdf version of pericardial effusion vs cardiac tamponade. Learn more about both conditions including epidemiology, etiology, pathology, pathophysiology, symptoms, diagnosis, therapy and prognosis.
Guidelines on the diagnosis and management of pericardial diseases. The management of pericardial diseases is largely empiric because of the relative lack of randomized trials. Cardiac tamponade is a medical emergency in which fluid in the pericardial sac acutely restricts the filling of the heart. The etiology of pericarditis is varied and includes infectious especially viral and tuberculosis and noninfectious causes autoimmune and autoinflammatory diseases, pericardial injury syndromes, and cancer especially lung cancer, breast cancer, and lymphomas. Pericardial effusion is a buildup of fluid in the pericardium. The pericardial effusion was demonstrated to be related to the underlying disease in all but 7 of these patients. Constrictive pericarditis cp is a relatively uncommon form of clinical heart failure. Compendium july 2007 402 ce canine pericardial effusion. The pericardial response to injury typically involves a spectrum of inflammation with both acute and chronic features andor fluid accumulation. Significant compression depends on whether tamponade is approached from a purely physiologic or clinical standpoint. Uremic pericarditis, the most common manifestation of. In contrast cardiac tamponade is a physiological diagnosis in which the pericardial effusion must be accompanied by evidence of obstructive shock.
Pericardial effusion can develop in patients with virtually any condition that affects the pericardium, including acute pericarditis and a variety of systemic disorders. Clinical update management of pericardial effusion massimo imazio1 and yehuda adler2 1department cardiology, maria vittoria hospital, via luigi cibrario 72, torino 10141, italy. The etiology of a pericardial effusion varies widely and can be divided into several categories. Guidelines on the diagnosis and management of pericardial. The pericardial space normally contains 15 50 ml of fluid cardiac temponade is acute heart failure due to compression of heart by a large or rapidly developing effusion. Diagnosis and treatment of pericardial effusion uptodate. Content of edema fluid mucopolysacharides hyalinorunic acid albumin mechanism albumin leak into interstitial and extra cellular space due to capillary dysfunction. As the pericardium is rather stiff, the capacity of the pericardial space is limited. To appreciate the role that the pericardium plays in the pathophysiology of chronic heart failure, it is necessary to make use of the concepts of pericardial restraint and ventricular interaction, pericardial pressurevolume and stressstrain relations, the nature and measurement of. Nsaids are the mainstay of empiric antiinflammatory therapy, with the possible.
Pericardial effusion is the presence of an abnormal amount of andor an abnormal character to fluid in the pericardial space. Cardiovascular magnetic resonance in pericardial diseases. A pericardial effusion is excess fluid between the heart and the sac surrounding the heart, known as the pericardium. In pericardial effusion, the pumping capacity of the heart is not affected, but in cardiac tamponade, there is a reduction in the pumping capacity of the heart. The mere presence of pericardial effusion does not necessarily imply pericardial infiltration by malignant cells.
Understanding the underlying cause is important in providing treatment recommendations. Cardiac tamponade resulting from pericardial effusion can be lifethreatening and is a medical emergency, requiring urgent drainage of the fluid. Not only the clinical presentation may be atypical, mimicking other. Pericardial diseases in patients with hypothyroidism heart. The pericardium is composed of visceral and parietal components. Management of pericardial effusion european heart journal. Cardiac tamponade is defined as significant compression of the heart by accumulating pericardial contents, including effusion fluids, blood, clots, pus, and gas, singly or in combinations. Today, despite improved knowledge of pathophysiology of pericardial diseases and the availability of a wide spectrum of diagnostic tools, the diagnostic challenge remains. The visceral pericardium is a mesothelial monolayer that adheres firmly to the epicardium, reflects over the origin of the great vessels, and becomes the serosal layer of the parietal pericardium, a tough, fibrous tissue which envelops the heart. Pathophysiology and causece 401 an indepth look return, ventricular filling, stroke volume, and cardiac output.
As the fluid volume and intrapericardial pressure increase, cardiac tamponade. Most cardiac tumors in infants and children are benign eg, rhabdomyoma and fibroma and are unlikely to be associated with pericardial involvement. Review clinical update management of pericardial effusion massimo imazio1 and yehuda adler2 1department cardiology, maria vittoria hospital, via luigi cibrario 72, torino 10141, italy. The sac normally contains a small amount of clear fluid between its layers. The presence of an abnormal amount of fluid in the pericardial space is known as pericardial effusion. An effusion appears as a transparent separation between the parietal and visceral pericardium during the cardiac cycle. The selection of the pericardial drainage procedure depends on the etiology of the effusion.
The incidence of pericardial effusion due to hypothyroidism ranges from 3% to 37%59 and most commonly found in states of severe hypothyroidism. This allows the heart to move smoothly against other organs in the chest as it beats. For tamponadefor tamponade prep and drape patientprep and drape patient while awake complications are rarecomplications are rare bleeding infectionbleeding, infection, incisional hernia, anesthetic complications. Pericarditis is an inflammation of the pericardium. Echocardiography none pericardial effusion evidence of pericardial constriction computed tomography noncontrast ct. Cardiac tamponade occurs when this fluid accumulates under pressure and obstructs diastolic filling of the heart. In the patients with no apparent cause of pericardial effusion at the time of diagnosis 40% we found that the presence of inflammatory signs characteristic chest pain, pericardial friction rub.
Pericardial effusion is fluid accumulation in the pericardial sac. Pericardial effusion is the acute or chronic accumulation of fluid in the pericardial space between the parietal and the visceral pericardium and is often associated with a variety of underlying disorders. The significance of effusions lies in their relationship to an underlying disease state and in their potential to affect a patients haemodynamics. The significance of effusions lies in their relationship to an underlying disease state and in their potential to affect a patients hemodynamics. The therapy of pericardial effusion should be targeted at the aetiology as much as possible.
Pericardial effusion and cardiac tamponade symptoms and ecg. Pericardial effusion leading to acute renal failure. Pericarditis is usually acute it develops suddenly and may last up to several months. Difference between pericardial effusion and cardiac tamponade. The pericardium and pericardial diseases in particular have received, in contrast to other topics in the field of cardiology, relatively limited interest. If you could see and touch it, the membrane around the heart would look red. Pathophysiology and causes of pericardial tamponade oxford. Pdf most cases of pericardial effusion can be diagnosed with a thorough physical examination.
Pericardial effusion can lead to cardiac tamponade which when left undetected or untreated is fatal. Pericardial window either to diagnose pericardial effusion or toeither to diagnose pericardial effusion or to manage tamponade. Guidelines on the diagnosis and management of pericardial diseases full text the task force on the diagnosis and management of pericardial diseases of the european society of cardiology task force members, bernhard maisch, chairperson germany, petar m. What is the pathophysiology of pericardial effusion. One hundred sixteen patients with moderate or large pericardial effusions were identified. Pericardial effusions can be caused by a number of etiologies and the fluid composing the effusion can be of varied consistency depending on its etiological basis. Pericardial effusion and cardiac tamponade summary pericardial effusion is the acute or chronic accumulation of fluid in the pericardial space between the parietal and the visceral pericardium and is often associated with a variety of underlying disorders. Understanding the underlying cause is important in providing treatment.
Pericardial effusion is a relatively common finding in everyday clinical practice. Pathophysiology and anatomy of tamponade physiology of the pericardial sac the pericardial sac consists of 2 layers of tough, fibrous tissues surrounding and protecting the heart. Sometimes the clinical picture of the patient leads directly to the search for pericardial effusion, as occurs in patients with chest pain of pericarditic characteristics or in patients with underlying diseases that can cause pericardial involvement renal failure, chest irradiation and thoracic. Pathophysiology and causes of pericardial tamponade. Pericardial effusion and cardiac tamponade knowledge for. Definition presence of an abnormal amount of fluid andor an abnormal character to fluid in the pericardial space. The pericardium is a 2layer sac that surrounds the heart. Pathophysiology and diagnosis of constrictive pericarditis. A pericardial effusion is considered to be present when accumulated fluid within the sac exceeds the small amount that is normally present. The pericardium is a fibroelastic sac made up of visceral and parietal layers separated by a potential space, the pericardial cavity. This can be considered as the major difference between pericardial effusion and cardiac tamponade. Most are not harmful, but they sometimes can make the heart work poorly. Uremic pericarditis, pericardial effusion, and constrictive.
The true population prevalence is unknown, but amongst those with viral pericarditis it has been estimated to occur in less than 0. It can be caused by a variety of local and systemic disorders, or it may be idiopathic. One patient was in cardiac tamponade, and the other was not yet in tamponade, as per echocardiographic criteria. Pdf etiology, management, and outcome of pediatric pericardial. Shows evidence of enlargement of the heart and congestion of the lungs. Evaluation of pericardial effusion differential diagnosis. The etiology of pericarditis is varied and includes infectious especially viral and tuberculosis and noninfectious causes autoimmune and autoinflammatory diseases, pericardial injury syndromes, and cancer especially lung cancer, breast cancer, and. Surgical pericardiectomy has the ability to cure cp, with dramatic improvements. Pericardial effusion is one of the most common clinically relevant cardiac complications in patients with hiv infection.
Pathophysiology and cause an indepth look embryonic development, resulting in incomplete separation of the abdominal and thoracic cavities. In one patient, the pericardial effusion was due to coxsackievirus infection, and in the other patient, it was due to lung cancer. In some cases, the clinical presentation of acute pericardial inflammation predominates, and the presence of excess pericardial fluid is clinically unimportant. Pdf etiological profile of pericardial effusion in kashmir. Nov 26, 2017 in pericardial effusion, the pumping capacity of the heart is not affected, but in cardiac tamponade, there is a reduction in the pumping capacity of the heart. Sep 22, 2016 this feature is not available right now. Pericarditis overview signs and symptoms, pathophysiology. Pathophysiology and anatomy of tamponade physiology of the pericardial sac.
Pericarditis cardiovascular disorders merck manuals. The procedure should be performed with the guidance of echocardiog raphy. Diagnosis and management of pericardial effusion ncbi. Pericardial effusions can be acute or chronic, and the time course of development has a great impact on the patients symptoms. Nov 28, 2018 pericardial effusion is the presence of an abnormal amount of andor an abnormal character to fluid in the pericardial space. Pericarditis, the most common disease of the pericardium, may be isolated or a manifestation of a systemic disease.
Difference between pericardial effusion and cardiac. Pericardial effusion refers to the accumulation of excess fluid within the pericardial sac. Significant compression depends on whether tamponade is approached from a. Rapid accumulation of pericardial fluid may cause elevated intrapericardial pressures with as little as 80 ml of fluid, while slowly progressing effusions can grow to 2 l without symptoms. Jul 03, 2019 pericardial effusion is a common cause of pericarditis, occurring in approximately 515% of us patients with malignant neoplasms, according to autopsy data. Physiologic pericardial fluid may only be visible during ventricular systole, whereas effusions exceeding 75100 ml are visualised throughout the cardiac cycle. Hypothyroidism is a classical example of generalised edema formation. Chronic pericardial effusion or chronic constrictive pericarditis may follow acute pericarditis of almost any etiology.
Pericardial effusion can also occur when the flow of pericardial fluid is blocked or when blood collects within the pericardium, such as from a chest trauma. Pericardial effusion fluid around the heart is an abnormal accumulation of fluid in the pericardial cavity. Pericardial effusion is a frequent finding that occurs due to primary pericardial disease or in relation to a myriad of systemic disease processes. In other cases, the effusion and its clinical consequences ie, cardiac tamponade and constrictive pericarditis are of primary importance. Mar, 2017 constrictive pericarditis cp is a relatively uncommon form of clinical heart failure. Pericardial effusion can result from inflammation of the pericardium pericarditis in response to illness or injury.
Pericardial pathophysiology is often manifested in a spectrum of distinct cardiac and systemic disease states. When pericardial effusion is associated with pericarditis, management should follow that of pericarditis. Clinical manifestations of pericardial effusion are highly dependent on the rate of accumulation of fluid in the pericardial sac. The prevalence of asymptomatic pericardial effusion has been reported in up to 70% to 100% of patients with uremic and dialysis pericarditis, which could be from either pericarditis or volume overload alone. Pericardial effusion symptoms and causes mayo clinic. Constrictive pericarditis occurs when there is a scar encasing, the heart that chronically constricts the filling of the heart. The most common causes of pericardial effusion include cardiac hemangiosarcoma, idiopathic pericardial effusion, and chemodectoma. Simple pericardiocentesis is usually sufficient in.
Reduced lymph clearance probably due to poor lymphatic. Pericardial effusion can have a wide range of manifestations including the asymptomatic effusion incidentally detected by echocardiography or routine chest imaging, cardiac tamponade, acute or chronic. Because of the limited amount of space in the pericardial cavity, fluid accumulation leads to an increased intrapericardial pressure which can negatively affect heart function. Uremic pericarditis, pericardial effusion, and constrictive pericarditis in endstage renal disease. Pericardial involvement in patients with malignancy is common. Most cases of pericardial effusions are caused by inflammation. Pericardial effusion is the abnormal accumulation of fluid in the pericardial cavity. Pericardial disease online medical reference discusses acute pericarditis, pericardial effusion and cardiac tamponade. Pericardial effusion and pericardiocentesis korean circulation.
Pathology of pericardial disease dr sampurna roy md. Hypothyroidism may cause pericardial effusion and cholesterol pericarditis. In healthy individuals, the pericardial cavity contains 15 to 50 ml of an ultrafiltrate of plasma. We describe two patients who developed acute renal failure secondary to severe pericardial effusion. Pericardial disease leading to pericardial effusion pef is a common clinical disorder. As the fluid volume and intrapericardial pressure increase, cardiac tamponade can develop. Additionally, rapid fluid accumulation in the pericardium can cause cardiac tamponade, a severe compression of the heart that impairs its ability to function. Pef that accumulates slowly can become quite large before haemodynamic embarrassment occurs, while pef that accumulates rapidly from trauma or aortic dissection can be small,yet cause haemodynamic. In addition, some cases occur without antecedent acute pericarditis. Pericardial effusion, and the possible inflammation of the pericardium resulting from it called pericarditis, can have many possible causes, including. Pericardial effusion an overview sciencedirect topics. Uremic pericarditis, pericardial effusion and constrictive.