Pericardial effusion natural history


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

Natural history and complications
Pericardial effusion if untreated or if refractory to treatment can lead to accumulation of large amount of fluid around the heart, severe hemodynamic compromise and even death. If the fluid accumulates too rapidly or is too large, then cardiac tamponade, a condition in which the heart is compressed by the fluid and cannot pump enough blood forward may occur. Cardiac tamponade may require urgent intervention including pericardiocentesis. This complication is more common in patients with specific underlying etiologies such as malignancy, tuberculosis, or purulent effusion and rarely occurs in idiopathic pericardial effusion.

If pericardial effusion lasts beyond 6months, then it is termed as chronic pericardial effusion and is usually well tolerated.

Idiopathic cause
Idiopathic pericardidial effusion is often self-limited and most patients recover in 2 weeks to 3 months. Idiopathic or viral pericardial disease is associated with a favorable long-term prognosis with few developing recurrences.

Tuberculous cause
The mortality rate associated with tuberculous pericardial disease in the preantibiotic era was 80-90%. The mortality rate is currently 8-17% The mortality is 17-34% if the tuberculous pericardial effusion is associated with HIV.

Traumatic Pericardial Injury
In penetrating injuries, pericardial effusion and tamponade may develop rapidly. Early detection and early treatment of cardiac tamponade is associated with a good prognosis. Minor perforations, isolated right ventricular wounds, and a systolic blood pressure more than 50 mm Hg are all associated with better outcomes.

Malignancy
Pericardial effusion secondary to malignancy is associated with poorer outcomes and a more complicated course.

Autoimmune Disease
Pericardial involvement in scleroderma and rheumatic fever is associated with worse outcomes.

Renal Failure
Pericardial disease secondary to renal failure is associated with significant morbidity and may result in hemorrhagic pericardial effusion