Pericardial effusion epidemiology and demographics


 * Associate Editor-In-Chief: Varun Kumar, M.B.B.S.

Epidemiology in Developed Countries
In developed countries malignancy is the leading cause of cardiac tamponade secondary to pericardial effusion. Malignant pericardial effusion is seen in approximately 50-60% of patients presenting with pericardial effusion who have history of malignancy. Among patients presenting with pericarditis or pericardial effusion with no history of malignancy, undiagnosed underlying malignancy was detected in 4-7%.

Viral infection is another leading cause of pericardial effusion  .Pericarditis most often affects men aged 20 - 50. It usually follows respiratory infections, most commonly echovirus or coxsackie virus. In children, it is most commonly caused by adenovirus or coxsackie virus. The incidence and prevalence of viral pericardial effusion varies with season and region.

Epidemiology in Developing Countries
Pericardial effusion secondary to HIV and tuberculosis is one of the major cause of acute pericarditis in developing countries. Tuberculous pericarditis, caused by Mycobacterium tuberculosis, is found in approximately 1% of all autopsied cases of TB and in 1% to 2% of instances of pulmonary TB. It accounted for 69.5% (162 of 233) of cases referred for diagnostic pericardiocentesis in a study in Western Cape Province of South Africa while the same accounts for 4% of cases in developed countries.

The incidence of pericardial effusion in patients with asymptomatic AIDS was 11% per year before the introduction of effective highly active antiretroviral therapy(HAART). The 6 month survival rate of AIDS patients with effusion was significantly shorter (36%) than the survival rate without effusions (93%). This shortened survival rate remained statistically significant after adjustment for lead-time bias and was independent of CD4 count and albumin level.

Impact of Gender
There is no sexual predilection observed in occurrence of pericardial effusion.

Age
Pericardial effusion occurs commonly in fourth or fifth decade of life. However, it can occur in all age groups. Patients with AIDS are at higher risk of developing effusion earlier when compared to general population.

Associated Conditions
Pericardial effusion can be associated with diseases such as autoimmune disorders, cancer, hypothyroidism, and kidney failure. It occurs in approximately in 13 percent of patients who are on maintenance hemodialysis. Hyperuricemia due to inadequate dialysis or fluid overload may be the reason for pericardial effusion. In regions where tuberculosis is not highly prevalent, malignancy may be the most common cause of a hemorrhagic effusion