Sunitha Daniel

 Brief Overview  Causes  Clinical Presentation  Investigations  Management Update

 Abnormal amount of and/or an abnormal character to fluid in the pericardial space.  Normal fluid ml  Among malignancies lung-highest prevalance(37%)

Primary  Acute inflammatory pericarditis (infectious- viral(HIV),bacterial,fungal autoimmune)  Previously unknown neoplasia  Idiopathic Secondary  Acute MI  Cardiac surgery  Trauma  Metastasis  Chest irradiation  End-stage renal failure  Hypothyroidism  Autoimmune diseases  Pulm HTN  Chylopericardium  Drugs : procainamide, hydralazine, INH, minoxidil, phenytoin, anticoagulants

Corey et alColombo et alSagristà-Sauleda et al Corey et al Effusion> 5 mm> 10 mm Not reported n Tamponade (%)Not reported4437Not reported Idiopathic (%) Chronic idiopathic effusion (%) ??9? Neoplastic (%) Uremia (%) Iatrogenic (%)00160 Post-acute myocardial infarction (%) 0880 Viral (%)14007 Collagen vascular disease (%) Tuberculosis (%)0022 Other (%)942120

Symptoms  Chest pain.  Syncope  Palpitations  Cough  Dyspneoa  Hoarseness Signs  Beck triad  Pulsus paradoxus  Pericardial friction rub  Tachycardia  Hepatojugular reflux  Tachypnea  Decreased breath sounds  Ewart sign  Weakened peripheral pulses, edema, and cyanosis.

Stage I - Diffuse ST- segment elevation and PR-segment depression Stage II - Normalization of the ST and PR segments Stage III - Widespread T-wave inversions: Stage IV - Normalization of the T waves

 Enlarged cardiac silhouette (water- bottle heart)  Pericardial fat stripe.  Pleural effusion(1/3)

 Echo-free space between the visceral and parietal pericardium  Small effusions < 10 mm and are generally seen posteriorly  Moderate mm and are circumferential.  Large :>20 mm

 loculated pericardial effusions.  CT detects 50ml fluid  MRI 30ml fluid.  MRI for hemorrhagic and non hemaorrhagic

 Based on etiology  Medical  Surgical

 Aspirin/NSAIDs – viral/idiopathic  Colchicine –relapsing pericarditis  Steroids- systemic inflammation/pregnancy/autoimmune  Antibiotics  Chemotherapy

 Diagnostic or therapeutic purposes  Not routinely for diagnosis-poor yield.  Strong suspicion of purulent or tuberculous pericarditis.  Malignancy  Asymptomatic patients with massive idiopathic chronic pericardial effusion

 Pericardiocentesis: idiopathic/viral  Indwelling pericardial catheter: neoplastic  Percutaneous ballon pericardiotomy  Subxiphoid pericardiotomy: purulent  Pleuropericardial window  Partial pericardiectomy  Wide anterior pericardiectomy

 relapses in as many as 40%-50% of patients  terminal patients-pericardiocentesis alone  patients with a longer expected survival- Indwelling pericardial catheters( 75% success rate)  Balloon pericardiotomy

 Diagnosis and management of pericardial effusion World J Cardiol May 26; 3(5): 135–143.  Management of pericardial effusion Eur Heart J first published online November 2, 2012 doi: /eurheartj/ehs372  overview