Materiały źródłowe

• #1 Pericardial Effusion: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17351-pericardial-effusion

  The pericardial effusion treatment you get depends on how severe your condition is and what caused it. […] If you have a small or medium-sized pericardial effusion that’s shrinking or not changing size, and you don’t have symptoms, you may not need any treatment. In these cases, your healthcare provider will probably want to monitor the effusion size and only treat it if you develop symptoms or if there are other signs that it might be a problem. […] If you have an effusion that’s growing more quickly, that’s causing symptoms or that’s happening because of more serious conditions (especially trauma or cancer), you’ll probably need treatment sooner rather than later. […] When a pericardial effusion is large or causes cardiac tamponade, it becomes a medical emergency that needs immediate treatment. Unlike smaller amounts, the pericardial fluid won’t go away unless you remove it. Potential treatments include:

• #1 Pericardial Effusion: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/157325-overview

  Most acute idiopathic or viral pericarditis occurrences are self-limited and respond to treatment with an NSAID. Colchicine or prednisone may be administered for severe inflammatory pericardial effusions or when NSAID treatment has failed. Colchicine is preferred over steroids (unless specifically indicated), as the latter is associated with an increased incidence of recurrent pericarditis. […] Autoimmune pericardial effusions may respond to treatment with anti-inflammatory medications. In general, selection of an agent depends on the severity of the patient’s symptoms and the tolerability and adverse-effect profiles of the medications. […] Pharmacotherapy for pericardial effusion includes use of the following agents, depending on the etiology: NSAIDs (eg, indomethacin, ibuprofen, naproxen, diclofenac, ketoprofen, aspirin), corticosteroids (eg, prednisone, methylprednisolone, prednisolone), anti-inflammatory agents (eg, colchicine), antibiotics (eg, vancomycin, ceftriaxone, ciprofloxacin, isoniazid, rifampin, pyrazinamide, ethambutol), antineoplastic therapy (eg, systemic chemotherapy, radiation), sclerosing agents (eg, tetracycline, doxycycline, cisplatin, 5-fluorouracil).

• #1 Pericardial Effusion Treatment & Management: Approach Considerations, Aspirin/NSAIDs, Colchicine

  https://emedicine.medscape.com/article/157325-treatment

  Patients with pericardial effusion who present with significant symptoms or cardiac tamponade require emergent treatment and admission to the intensive care unit (ICU). […] Patients should be educated with regard to symptoms of increasing pericardial effusion and should be evaluated whenever these symptoms begin to occur. […] Symptomatic patients requiring treatment (who are surgical candidates) should receive care at an institution with cardiothoracic surgery capabilities. […] A cardiologist should be involved in the care of patients with pericardial effusion. Cardiothoracic surgery may be required for recurrent or complicated cases. […] In patients with purulent pericarditis, urgent pericardial drainage combined with intravenous (IV) antibacterial therapy (eg, vancomycin 1 g bid, ceftriaxone 1-2 g bid, and ciprofloxacin 400 mg daily) is mandatory.

• #1 Pericardial Effusion Treatment & Management: Approach Considerations, Aspirin/NSAIDs, Colchicine

  https://emedicine.medscape.com/article/157325-treatment

  The initial treatment of tuberculous pericarditis should include isoniazid 300 mg daily, rifampin 600 mg daily, pyrazinamide 15-30 mg/kg daily, and ethambutol 15-25 mg/kg daily. […] Patients who have an effusion with actual or threatened tamponade should be considered to have a true or potential emergency. Most patients require pericardiocentesis to treat or prevent tamponade. […] As previously mentioned, pericardiocentesis is used for diagnostic as well as therapeutic purposes. […] Complications of pericardiocentesis include ventricular rupture, dysrhythmias, pneumothorax, myocardial and/or coronary artery laceration, and infection. […] In this procedure, a catheter is placed in the pericardial space under fluoroscopy. […] Video-assisted thoracic surgery (VATS) allows resection of a wider area of the pericardium than the subxiphoid approach does, without the morbidity of thoracotomy.

• #1 Pericardial Effusion: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17351-pericardial-effusion

  In cases where an effusion isn’t dangerous and doesn’t need any of the above treatments, a provider can often manage it with medications or other types of treatments. The treatments depend on the underlying cause. These include, but aren’t limited to, the following: […] Antibiotics for infections like tuberculosis. […] Anti-inflammatory drugs to help reduce inflammation and swelling. […] Chemotherapy and radiation therapy for people whose pericardial effusion happens because of cancer. […] Diuretics and other medications for people with heart failure as the cause of their pericardial effusion. […] A possible complication is pericardial decompression syndrome when you undergo a procedure or surgery to treat a pericardial effusion. While it isn’t common, it is severe and life-threatening. It usually happens when fluid removal happens too quickly from a large effusion. To avoid this, your healthcare provider may drain the effusion more slowly.

• #1 Diagnosis and management of pericardial effusion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3110902/

  The therapeutic possibilities include extended indwelling pericardial catheter, percutaneous pericardiostomy and intrapericardial instillation of antineoplastic and sclerosing agents. […] Massive chronic idiopathic pericardial effusions do not respond to medical treatment and tend to recur after pericardiocentesis, so wide anterior pericardiectomy is finally necessary in many cases. […] Patients with acute inflammatory signs (fever, chest pain, pericardial friction rub) should receive aspirin or non-steroid anti-inflammatory drugs. […] Colchicine is an established indication in patients with relapsing pericarditis, and has also been suggested to be useful in the first episode of acute pericarditis in order to avoid the appearance of recurrences. […] Pericardial drainage procedures can be performed for diagnostic or therapeutic purposes (patients with cardiac tamponade).

• #1 Diagnosis, treatment, and management of pericardial effusion- review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9283797/

  The latest 2015 ESC Guidelines on the management of pericardial diseases present a Class I Recommendation for performing pericardiocentesis for moderate to large effusions. […] Therefore, often in emergency settings such as a patient arriving with severe cardiac tamponade the first-line treatment is pericardiocentesis. […] While pericardiocentesis is usually the first-line therapy to drain excess fluid, in cases that make pericardiocentesis high risk e.g., in patients with malignant and recurrent pericardial effusion, a pericardial window is a safer alternative. […] A pericardial window is a surgical technique usually preferred as an effective approach to avoid recurrent effusion in long term as compared to pericardiocentesis. […] In clinical practice, while numerous percutaneous techniques are commonly used as the first line of therapy to treat pericardial effusion, cardiologists are also inclined towards pharmaceutical therapies for critical cases, specifically cases of recurrence in malignant pericardial effusion. Sclerosing therapy use agents such as colchicine, bleomycin, doxycycline, tetracycline, cisplatin, etc. to induce inflammatory adhesion of the pericardial layers preventing re-accumulation of the pericardial fluid. […] The early and effective treatment of malignant pericardial effusion is possible through sclerosing therapy as it mostly remains undiagnosed until cardiac tamponade compromises the hemodynamic stability of the patient.

• #1 Diagnosis, treatment, and management of pericardial effusion- review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9283797/

  The hemodynamic stability of the heart and pericardium are maintained by the pericardial fluid of volume 1050 ml. […] Once diagnosed, there are numerous treatment options available for the management of patients with pericardial effusion. These include various invasive and non-invasive strategies such as pericardiocentesis, pericardial window, and sclerosing therapies. […] Pericardial effusion is primarily managed by various invasive and non-invasive strategies. When pericardial fluid builds up, the chambers of the heart are unable to pump adequate stroke volume of blood, leading to pericardial effusion and tamponade, which is considered a cardiac emergency. The accumulated fluid can be removed through pericardiocentesis, in which a needle and a small catheter drain the excess fluid from the pericardial sac.

• #1 Pericardiocentesis: Details & Recovery

  https://my.clevelandclinic.org/health/treatments/22613-pericardiocentesis

  Pericardiocentesis is a procedure that drains extra fluid from around your heart. Its often a treatment for a life-threatening condition that can stop your heart. […] A pericardiocentesis procedure treats pericardial effusion, or too much fluid in your pericardium. […] A provider can use pericardiocentesis as an emergency or non-emergency treatment. In emergencies, pericardiocentesis treats either cardiac tamponade or severe pericardial effusions that will cause cardiac tamponade. […] Pericardiocentesis is a relatively common procedure. Providers in the United States perform more than 29,000 of these procedures each year. […] Studies have found success rates higher than 90% (with some as high as 100%) for a pericardiocentesis procedure. […] Depending on the cause and treatment options, fluid can continue to build up after the initial drainage. If this happens, your provider might recommend you see a surgeon to discuss a more permanent procedure called a pericardial window.

• #1 Pericardial Effusion: Causes, Symptoms, Diagnosis & Treatment

  https://www.webmd.com/heart-disease/pericardial-effusion

  The treatment of a pericardial effusion depends on its severity and cause. […] For a large effusion or cardiac tamponade, the fluid must be drained. This will likely be done through one of the following methods: […] Pericardiocentesis to pull the extra fluid out with a needle. If necessary, your doctor may leave a tube in your chest (pericardial drain) for a few days to drain the fluid completely. […] Surgery to remove the extra fluid. The type of procedure your doctor uses will depend on what’s causing your effusion, how you are doing physically, and how well your doctors think you will handle the surgery. […] This may be done using any of several procedures, such as: […] Percutaneous balloon pericardiotomy. Your surgeon will use X-rays to guide them as they insert a long, thin tube with a small balloon on the end into your pericardium. They will make a small hole in it and inflate the balloon to make the hole bigger so that the extra fluid can drain out.

• #1 Pericardial effusion and tamponade – Diagnosis and Treatment Summary : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericardial-effusion-and-tamponade-diagnosis-and-treatment-summary/

  Pericardial fluid drainage can be diagnostic as well therapeutic. […] In ED done for urgent relief of hemodynamic compromise using percutaneous catheter (pericardiocentesis) under US guidance. […] Alternately echocardiogram guided pericardiocentesis or an open surgical drainage if subacute or chronic. […] The indications for urgent pericardial fluid drainage depend on the patient’s hemodynamic compromise. […] If clinical and point-of-care cardiac ultrasound findings indicate hemodynamic compromise → urgent pericardial drainage is needed. […] Pericardiocentesis under echocardiographic guidance is recommended for most patients. […] Surgical drainage is recommended if: Bleeding into pericardium from trauma or aortic dissection. […] Post-infarction ventricular wall rupture. […] Reaccumulation of fluid after previous pericardiocentesis.

• #1 Pericardial Effusion | Clinical Heart and Vascular Center | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/pericardial-effusion/

  Common treatments include: […] Medications: Aspirin, nonsteroidal anti-inflammatory drugs, steroids, and/or antibiotics can reduce inflammation. […] Fluid draining: This minimally invasive procedure drains the accumulated fluid, helps identify the cause of the accumulation, and relieves the pressure on the heart. This pressure relief might be temporary, and another draining procedure might be necessary. In that case, a temporary catheter can be placed. […] Thoracoscopic pericardial window surgery: This minimally invasive, video-assisted thoracoscopic surgery (VATS) enables surgeons to see a wider area of the pericardium and the pleural region through two to four tiny incisions and to create an opening (window) in the pericardium large enough for the fluid to drain internally and avoid collection in the pericardium.

• #1 Pericardial Effusion in Cats | VCA Animal Hospitals

  https://vcahospitals.com/know-your-pet/pericardial-effusion-in-cats

  In some cases, pericardial effusion may be treated with a procedure called a pericardectomy. In a pericardectomy, a small opening (window) is made in the pericardium. This allows accumulating fluid to drain out of the pericardium into the surrounding tissues, alleviating pressure on the heart. In some cases, this treatment is curative; in other situations, it is attempted only for palliative care. […] If pericardial effusion is associated with a peritoneopericardial diaphragmatic hernia, surgery is required to correct the hernia.

• #1 Pericardial involvement in neoplastic disease: prevalence, clinical picture, diagnosis and treatment

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Pericardial-involvement-in-neoplastic-disease-prevalence-clinical-picture-diagnosis-and-treatment

  Depending on the underlying neoplasm, sclerosing and cytotoxic agents are instilled intrapericardially to prevent recurrence. […] In pericardial effusions secondary to radiosensitive tumours such as lymphomas and leukaemia, radiation therapy is the therapy of choice but has the risk of causing pericarditis and myocarditis. […] As malignant pericardial effusions have high recurrence rates, pericardiocentesis alone may not be sufficient. […] Pericardiectomy is the treatment of choice in chronic constrictive pericarditis. Complete pericardiectomy is favoured over partial, as constrictive symptoms may linger on after partial pericardiectomy. […] The approach to malignant pericardial disease management is usually based on the type and stage of the primary illness and the general medical condition of the patient.

• #1 Diagnosis and management of pericardial effusion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3110902/

  Pericardial drainage is mandatory when clinical tamponade is present. […] In the absence of clinical tamponade, examination of the pericardial fluid is indicated when there is a clinical suspicion of purulent pericarditis and in patients with underlying neoplasia. […] Patients with chronic massive idiopathic pericardial effusion should also be submitted to pericardial drainage because of the risk of developing unexpected tamponade. […] The selection of the pericardial drainage procedure depends on the etiology of the effusion. […] Simple pericardiocentesis is usually sufficient in patients with acute idiopathic or viral pericarditis. […] Purulent pericarditis should be drained surgically, usually through subxiphoid pericardiotomy. […] Neoplastic pericardial effusion constitutes a more difficult challenge because reaccumulation of pericardial fluid is a concern.

• #1 Pericardial Effusion Treatment & Management: Approach Considerations, Aspirin/NSAIDs, Colchicine

  https://emedicine.medscape.com/article/157325-treatment

  Pharmacotherapy for pericardial effusion may include use of the following agents, depending on etiology: Aspirin/NSAIDs, Colchicine, Steroids, Antibiotics. […] Antineoplastic therapy (eg, systemic chemotherapy, radiation) in conjunction with pericardiocentesis has been shown to be effective in reducing recurrences of malignant effusions. Corticosteroids and NSAIDs are helpful in patients with autoimmune conditions. […] Several pericardial sclerosing agents have been used with varying success rates (eg, tetracycline, doxycycline, cisplatin, 5-fluorouracil). The pericardial catheter may be left in place for repeat instillation if necessary until the effusion resolves. […] Surgical treatments for pericardial effusion include the following: Pericardiostomy, Pericardotomy, Thoracotomy, Sternotomy, Pericardiocentesis.

• #1 Pericardial effusion in oncological patients: current knowledge and principles of management | Cardio-Oncology | Full Text

  https://cardiooncologyjournal.biomedcentral.com/articles/10.1186/s40959-024-00207-3

  This article provides an up-to-date overview of pericardial effusion in oncological practice and a guidance on its management. Furthermore, it addresses the question of when malignancy should be suspected in case of newly diagnosed pericardial effusion. […] Drainage, which is mainly attained by pericardiocentesis, is needed when cancer or cancer treatment-related pericardial effusion leads to hemodynamic impairment. Placement of a pericardial catheter for 2-5 days is advised after pericardial fluid removal. […] Pericardial effusion secondary to immune checkpoint inhibitors typically responds to corticosteroid therapy. […] Pericardial drainage is usually not necessary in the absence of hemodynamic impairment. Nevertheless, pericardiocentesis with cytological examination may be carried out to establish the etiology of the pericardial effusion, and to steer the diagnostic workup towards other causes if cancer cells are not found.

• #1 11. Pericardial Effusion and Cardiac Tamponade | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/11-pericardial-effusion-and-cardiac-tamponade/11-pericardial-effusion-and-cardiac-tamponade

  If you suspect tamponade, obtain a STAT bedside echo and prepare for possible pericardiocentesis. […] Treatment of tamponade: Pericardiocentesis, possibly with indwelling drain if reaccumulation is expected. […] Pericardial effusions without tamponade can usually be managed conservatively. Consider pericardiocentesis for purulent effusions or if suspicion of infection/malignancy exists; diagnostic yield is quite low, however. […] Pericardial window by CT surgery should be entertained (hole cut in pericardial sac to allow pericardial fluid to be drained into the pleural space) in cases where fluid is expected to continue to accumulate despite initial removal (e.g. malignancy where treatment is unlikely to quickly decrease pericardial fluid accumulation).

• #1 Pericardiocentesis: Details & Recovery

  https://my.clevelandclinic.org/health/treatments/22613-pericardiocentesis

  Pericardiocentesis complications happen in about 5% to 40% of cases. […] Even with imaging, a pericardiocentesis procedure involves inserting a needle very close to several of your vital organs and major blood vessels. […] Your healthcare provider will schedule follow-up visits to ensure you dont have any complications or additional need for treatment. Some people will need more than one procedure because pericardial effusions can happen more than once. […] It may be scary to see a needle coming at you and going toward your heart. But pericardiocentesis is a proven way to relieve the pressure and symptoms of severe pericardial effusion and cardiac tamponade.

• #1 Management of acute pericarditis: treatment and follow-up

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Management-of-acute-pericarditis-treatment-and-follow-up

  Initial management of acute pericarditis should be focused on screening for specific causes which will determine the choice of therapy. Hospital admission is recommended for high-risk patients with acute pericarditis. Colchicine use is a first-line therapy for acute pericarditis as an adjunct to aspirin/NSAIDs therapy for three months. Corticosteroids are not recommended as first-line therapy for acute pericarditis as they appear to encourage recurrences. Serum CRP should be considered to guide the treatment length and assess the response to therapy. Evaluation of response to anti-inflammatory therapy is recommended after one week.

• #1

  https://link.springer.com/article/10.1007/s11886-021-01539-7

  Pericardial effusion is a challenging pericardial syndrome and a cause of serious concern for physicians and patients due to its potential progression to life-threatening cardiac tamponade. […] Actually, current guidelines suggest a 4-step treatment algorithm depending on the presence or absence of hemodynamic impairment; the elevation of inflammatory markers; the presence of a known or first-diagnosed underlying condition, possibly related to pericardial effusion; and finally the duration and size of the effusion. […] In contrast to earlier perceptions, based on the most recent evidence, it seems that in the subgroup of asymptomatic patients with large ( 2-cm end-diastolic diameter), chronic ( 3 months) C-reactive protein negative, idiopathic (without an apparent cause) pericardial effusion, a conservative approach is the most reasonable option. […] Apart from general recommendations applied to all cases, an individualized, etiologically driven treatment is of paramount importance.

• #2 FF #209 Malignant Pericardial Effusions | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/malignant-pericardial-effusions/

  Malignant pericardial effusions (MPEs) are a rare complication of advanced cancer, but are associated with high morbidity and mortality. This Fast Fact discusses the diagnosis and management of MPEs. […] Treatment Options […] Systemic chemotherapy or radiotherapy are effective for chemo- or radio-sensitive tumors such as previously untreated breast cancer and many lymphomas. Reaccumulation rates for both modalities are about 1/3 overall, depending on the patient’s overall course and response to therapy. […] Pericardiocentesis results in immediate symptom relief in most patients, however the effusion may re-accumulate, requiring repeat pericardiocentesis (within 1-2 weeks in some series). […] Pericardial sclerosis involves instilling a sclerosing agent with the intention of scarring the pericardium to the epicardium, preventing reaccumulation of the MPE.

• #2 Pericardial effusion – Victor Chang Cardiac Research Institute

  https://www.victorchang.edu.au/pericardial-effusion

  Treatment for pericardial effusion will depend on how much fluid is present and the cause. […] Cases of small to moderate fluid build up that are causing no symptoms and/or are shrinking in size may only require regular monitoring. If treatment is required for a small-moderate pericardial effusion, this is likely to include medication to treat the cause, such as: nonsteroidal anti-inflammatory drugs (NSAIDs) and/or colchicine for inflammation, diuretics for those with heart failure, antibiotics for infections. […] In cases where the pericardial effusion is large or causes cardiac tamponade, urgent treatment is required. This may include: fluid drainage using a needle (pericardiocentesis), heart surgery.

• #2 Pericardial Effusion: Causes, Symptoms, Diagnosis & Treatment

  https://www.webmd.com/heart-disease/pericardial-effusion

  If your effusion isn’t dangerous and doesn’t need to be drained immediately, your doctor will likely treat the cause. This will also treat the effusion. Such treatments may include: […] Antibiotics, which will treat any bacterial infections, such as tuberculosis […] Anti-inflammatory drugs, which will reduce any inflammation and swelling […] Chemotherapy and radiation therapy if you have cancer […] Diuretics and other medicines if you have heart failure.

• #2 Management of acute pericarditis: treatment and follow-up

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Management-of-acute-pericarditis-treatment-and-follow-up

  Acute pericarditis is a self-limiting disease without significant complications or recurrences in 70% to 90% of patients. If the laboratory data support the clinical diagnosis, symptomatic treatment with aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) with gastroprotection should be initiated. Colchicine is recommended first-line therapy as an adjunct to aspirin/NSAIDs. Low-dose corticosteroids should be considered in cases of contraindications/failure of aspirin/NSAIDs and colchicine, and when an infectious cause has been excluded, or when there is a specific indication such as autoimmune disease. Serum CRP guides the treatment length and response to therapy. […] Aspirin or NSAIDs are mainstays of therapy for acute pericarditis. If laboratory data support the clinical diagnosis, symptomatic treatment with NSAIDs should be initiated. Because of its excellent safety, the preferred NSAIDs is ibuprofen in a dose of 600 to 800 mg orally, three times daily with discontinuation if pain is no longer present after two weeks.

• #2 Management of acute pericarditis: treatment and follow-up

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Management-of-acute-pericarditis-treatment-and-follow-up

  Colchicine is recommended at low, weight-adjusted doses to improve the response to medical therapy and to prevent recurrences. Colchicine is administered as a 2-to-3-mg oral loading dose followed by 1 mg daily for three months. It is unusual not to achieve a satisfactory response to a regimen of NSAIDs with colchicine added. Colchicine has been proposed as a standard adjuvant to NSAIDs for initial treatment. […] Poorly responding patients have typically been treated with short courses of corticosteroids. Corticosteroids should be considered as a second option in patients with contraindications and failure of aspirin or NSAIDs because of the risk of favouring the chronic evolution of the disease and promoting drug dependence. In this case they are used with colchicine. However, corticosteroids should be avoided as they appear to encourage recurrences.

• #2 Pericardiocentesis: Details & Recovery

  https://my.clevelandclinic.org/health/treatments/22613-pericardiocentesis

  Pericardiocentesis is a procedure that drains extra fluid from around your heart. Its often a treatment for a life-threatening condition that can stop your heart. […] A pericardiocentesis procedure treats pericardial effusion, or too much fluid in your pericardium. […] A provider can use pericardiocentesis as an emergency or non-emergency treatment. In emergencies, pericardiocentesis treats either cardiac tamponade or severe pericardial effusions that will cause cardiac tamponade. […] Pericardiocentesis is a relatively common procedure. Providers in the United States perform more than 29,000 of these procedures each year. […] Studies have found success rates higher than 90% (with some as high as 100%) for a pericardiocentesis procedure. […] Depending on the cause and treatment options, fluid can continue to build up after the initial drainage. If this happens, your provider might recommend you see a surgeon to discuss a more permanent procedure called a pericardial window.

• #2 Pericardial effusion and tamponade – Diagnosis and Treatment Summary : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericardial-effusion-and-tamponade-diagnosis-and-treatment-summary/

  Pericardial fluid drainage can be diagnostic as well therapeutic. […] In ED done for urgent relief of hemodynamic compromise using percutaneous catheter (pericardiocentesis) under US guidance. […] Alternately echocardiogram guided pericardiocentesis or an open surgical drainage if subacute or chronic. […] The indications for urgent pericardial fluid drainage depend on the patient’s hemodynamic compromise. […] If clinical and point-of-care cardiac ultrasound findings indicate hemodynamic compromise → urgent pericardial drainage is needed. […] Pericardiocentesis under echocardiographic guidance is recommended for most patients. […] Surgical drainage is recommended if: Bleeding into pericardium from trauma or aortic dissection. […] Post-infarction ventricular wall rupture. […] Reaccumulation of fluid after previous pericardiocentesis.

• #2 Pericardial effusion in oncological patients: current knowledge and principles of management | Cardio-Oncology | Full Text

  https://cardiooncologyjournal.biomedcentral.com/articles/10.1186/s40959-024-00207-3

  A pericardial catheter may be left after pericardiocentesis for some days to promote adherence of pericardial layers, until minimal (30 mL/24 hours) or no liquid is drained. […] Creation of thoracoscopic or surgical pericardial window, usually into the pleural space, is another mean to prevent relapse of pericardial effusion. […] Drainage of pericardial effusion secondary to ICI therapy is rarely needed, since it normally responds to transient interruption of ICIs and corticosteroids. […] In case of clinically significant CTR-pericardial effusion, multidisciplinary discussion between the cardiologist and the oncologist/hematologist is fundamental to decide whether cancer treatment can be safely continued. […] Finally, pericarditis with pericardial effusion occurring in oncological patients, but unrelated to cancer or its treatment, should be managed like in the general population with colchicine and non-steroidal anti-inflammatory drugs.

• #2 Diagnosis and management of pericardial effusion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3110902/

  In patients without hemodynamic compromise the diagnostic yield of pericardial fluid or pericardial tissue is very low. […] Pericardiocentesis is the first option in patients with overt tamponade. […] In cases with relapsing effusion, a second pericardiocentesis is warranted. […] When a large pericardial effusion relapses after two pericardiocenteses we recommend surgical drainage with wide anterior pericardiectomy even in asymptomatic patients. […] The management of cardiac tamponade in patients with neoplastic pericardial involvement merits a special comment. […] Simple pericardiocentesis alleviates symptoms in most cases but pericardial effusion relapses in as many as 40%-50% of patients. […] Indwelling pericardial catheters have a success rate (defined as alleviation of tamponade and no need of further procedures) of 75% approximately.

• #2 Pericardial Effusion | Saint Luke’s Health System

  https://www.saintlukeskc.org/health-library/pericardial-effusion

  Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is and what caused it. Chronic and acute pericardial effusions may require different treatment. […] If a pericardial effusion is not severe, treatment may include: […] Therapy aimed at the cause of the effusion, such as antibiotics for a bacterial infection, or medicines like ibuprofen for inflammation […] A severe pericardial effusion may need to be drained. The fluid is drained with a procedure called pericardiocentesis. This procedure uses a needle and a thin, flexible tube (catheter) to drain the fluid. […] In some cases, the pericardial sac may be drained during surgery. The surgeon may remove a piece of the pericardium. This is called a pericardial window, or pericardiectomy. This can also be done to help diagnose the cause of the effusion and prevent the fluid from building up again. […] Symptoms often improve greatly after the excess fluid is drained. The outcome of treatment may depend on the cause and severity of the condition, how quickly treatment is started, and your overall health.

• #2 Management of Pericardial Effusions – When to Intervene, and How? – Canadian Association of Thoracic Surgeons

  https://www.canadianthoracicsurgeons.ca/2020/09/22/management-of-pericardial-effusions-when-to-intervene-and-how/

  5. Surgical pericardiotomy and drainage is recommended in the following cases: Patients with surgical tamponade (i.e. secondary to aortic dissection or post-infarction myocardial rupture) due to risk of exacerbating the dissection or rupture after rapid pericardial decompression and restoration of systemic arterial pressure with percutaneous techniques, Recurrent and/or loculated pericardial effusions, If biopsy of the pericardium is required for diagnostic purposes, Patients on anticoagulant therapy, or those with uncorrected coagulopathy, and/or thrombocytopenia (platelet count 50,000/mm3). […] 6. Surgical approach: both VATS and subxiphoid pericardial window have similar efficacy. Choice of surgical technique may vary based on surgeon experience, and patient factors including hemodynamic status (positioning and need for single-lung ventilation for the VATS approach may impede emergent access), as well as the need to perform concurrent procedures such as lung/pleural biopsies or drainage of concurrent pleural effusions (facilitated by a VATS approach).

• #2 Pericardial Effusion | Clinical Heart and Vascular Center | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/pericardial-effusion/

  Pericardial window surgery (subxiphoid pericardiostomy): A four- to five-centimeter vertical linear incision is made at the highest point in the midline abdomen to open the pericardium and allow the fluid to drain internally or externally to relieve pressure on the heart. Very small drains that are placed to eliminate the fluid are removed in the outpatient clinic. This procedure can be performed in less than 30 minutes, and patients often can return home the next day.

• #2 Pericardial Effusion: Causes, Symptoms, Treatment and Cost

  https://www.lybrate.com/topic/pericardial-effusion

  The underlying cause of pericardial effusion as well as the treatment modality will determine how successful the patient’s therapy will be. In some cases, the effusion may be resolved permanently if treated with medication or through a procedure, such as pericardiocentesis. In other cases, the effusion may recur or become chronic and require ongoing management. […] Post treatment for pericardial effusion typically includes observation, drainage of the effusion if necessary, medical therapy and rarely, surgical intervention. […] Anti-inflammatory drugs such as non-steroidal anti-inflammatories (NSAIDs) may be used to reduce inflammation in the pericardium which can help reduce the size of the effusion. […] If medical management fails or is not possible, surgical intervention may be necessary to remove part of the pericardium and drain any remaining fluid from around it (pericardiectomy).

• #2 Understanding Pericardial Effusion | UNC Health Talkhealth wellnessstethoscopeStorieshealth wellnessstethoscopeStoriestwitter-iconfacebook-iconpinterest-iconemail-iconhealth wellnessstethoscopeStoriesfacebooktwitteryoutubepinterestinstagramLinkedIn

  https://healthtalk.unchealthcare.org/understanding-pericardial-effusion/

  Pericardial effusion is typically diagnosed at the hospital after someone has been admitted because of their symptoms. To treat pericardial effusion, doctors must remove the excess fluid, Dr. Jobe says. […] As an interventional cardiologist, Dr. Jobe performs a nonsurgical, catheter-based procedure called pericardiocentesis to treat pericardial effusion. During pericardiocentesis, a doctor threads a catheter into the sac surrounding the heart to drain built-up fluid and relieve symptoms. Medical professionals then test the fluid for signs of infection, cancer or other problems. […] Not all patients can be treated successfully with pericardiocentesis. Some may require a surgical procedure called pericardial window. In this procedure, a heart surgeon cuts away a small piece of the pericardium. This causes the fluid to drain and prevents fluid from building back up. […] In the most difficult cases, a larger part or sometimes all of the pericardium might need to be removed. This is called a pericardiectomy or pericardial stripping operation, and it is typically done only after less invasive procedures are unsuccessful.

• #2 Pericardial Effusion: Symptoms, Causes and Treatments

  https://www.asbestos.com/mesothelioma/pericardial/effusion/

  Pericardiocentesis is a procedure that removes excess fluid surrounding the heart muscle. Doctors use this approach to diagnose and treat a pericardial effusion. […] A pericardiectomy is surgery to remove the pericardium from around the heart. Doctors may remove only the affected part of the pericardium. This is called a partial pericardiectomy. A total pericardiectomy removes as much of the pericardium as possible. […] Pericardiocentesis is effective for treating pericardial effusions. They are also simple to perform and can be done at the bedside in the hospital. However, it is possible the effusion returns after pericardiocentesis. […] The pericardiectomy procedure is more intensive than pericardiocentesis, but it is less likely that the effusion will return. Your doctor will weigh the pros and cons of each procedure with you to determine which is best. They will check your health and your ability to tolerate open-heart surgery with pericardiectomy.

• #2 Diagnosis and management of pericardial effusion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3110902/

  The therapeutic possibilities include extended indwelling pericardial catheter, percutaneous pericardiostomy and intrapericardial instillation of antineoplastic and sclerosing agents. […] Massive chronic idiopathic pericardial effusions do not respond to medical treatment and tend to recur after pericardiocentesis, so wide anterior pericardiectomy is finally necessary in many cases. […] Patients with acute inflammatory signs (fever, chest pain, pericardial friction rub) should receive aspirin or non-steroid anti-inflammatory drugs. […] Colchicine is an established indication in patients with relapsing pericarditis, and has also been suggested to be useful in the first episode of acute pericarditis in order to avoid the appearance of recurrences. […] Pericardial drainage procedures can be performed for diagnostic or therapeutic purposes (patients with cardiac tamponade).

• #2 Cardiac Tamponade | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/cardiac-tamponade.html

  Cardiac tamponade is often a medical emergency and quick removal of the pericardial fluid is needed. The most common procedure to do so is called a pericardiocentesis. A needle and a long thin tube (a catheter) are used to remove the fluid. […] In certain cases, healthcare providers might drain the pericardial sac during surgery instead. In some cases, the surgeon removes some of the pericardium. That can help diagnose the cause of the tamponade. It can also prevent the fluid from building up again. This is called a pericardial window. […] Other therapies are often given in addition to fluid removal include: Therapy aimed at the cause of the fluid buildup. This might be antibiotics for a bacterial infection. […] Medicine or fluids to increase blood pressure […] Pain medicine, such as aspirin […] Anti-inflammatory medicines, such as aspirin, ibuprofen, steroids, or colchicine […] Medicines to help the heart beat stronger […] Blood transfusion. You may need this if the fluid buildup is caused by trauma or is after open heart surgery.

• #2 Management of Pericardial Effusions – When to Intervene, and How? – Canadian Association of Thoracic Surgeons

  https://www.canadianthoracicsurgeons.ca/2020/09/22/management-of-pericardial-effusions-when-to-intervene-and-how/

  Pericardial effusions are often classified based on size, with small effusions (50-100mL) measuring less than 10mm in thickness, moderate effusions (100-500mL) measuring 10-20mm in thickness, and large effusions (500mL) measuring more than 20mm in thickness on echocardiographic assessment. […] Optimal therapy often involves medical treatment of the underlying etiology of the effusion. However, pericardial fluid drainage (via pericardiocentesis or surgery) may be required for large, recurrent, loculated, and/ or hemodynamically significant effusions. […] 1. Percutaneous pericardiocentesis (echocardiography, fluoroscopy, or CT guided) is recommended in the following cases: Patients with evidence of hemodynamic compromise (i.e. cardiac tamponade), Symptomatic moderate to large pericardial effusions non-responsive to medical therapy, Patients suspected to have tuberculous, neoplastic or bacterial pericarditis, Patients with large (20mm on echocardiography in diastole) idiopathic chronic (3months) pericardial effusions to minimize the risk of overt cardiac tamponade.

• #2 Managing pericardial effusion in the dog (Proceedings)

  https://www.dvm360.com/view/managing-pericardial-effusion-dog-proceedings

  ECG should be monitored during and after pericardiocentesis for the presence of arrhythmias induced by catheter-associated irritation of the epicardium and decreased myocardial oxygen delivery experienced during cardiac tamponade. […] Pericardiocentesis is most often performed from the right hemithorax because injury to the left coronary artery is unlikely, and the cardiac notch is slightly larger. […] Monitoring for recurrence of fluid accumulation by frequent reassessment of major body systems, physical examination and echocardiography is useful. […] Prognosis for dogs with pericardial effusion will depend on the underlying cause of the disease. Surgical removal of a mass on the right atrial appendage will at least temporarily alleviate signs of recurrent pericardial effusion. […] Treatment with fresh frozen plasma, vitamin K1, and pericardiocentesis will be curative for dogs with anticoagulant rodenticide intoxication. […] Culture and sensitivity based antimicrobial therapy surgical debridement is indicated for the management of infectious pericarditis. […] Rapid identification of problems and institution of treatment will maximize the likelihood of a positive outcome.

• #2 Pericardial Effusion: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17351-pericardial-effusion

  In cases where an effusion isn’t dangerous and doesn’t need any of the above treatments, a provider can often manage it with medications or other types of treatments. The treatments depend on the underlying cause. These include, but aren’t limited to, the following: […] Antibiotics for infections like tuberculosis. […] Anti-inflammatory drugs to help reduce inflammation and swelling. […] Chemotherapy and radiation therapy for people whose pericardial effusion happens because of cancer. […] Diuretics and other medications for people with heart failure as the cause of their pericardial effusion. […] A possible complication is pericardial decompression syndrome when you undergo a procedure or surgery to treat a pericardial effusion. While it isn’t common, it is severe and life-threatening. It usually happens when fluid removal happens too quickly from a large effusion. To avoid this, your healthcare provider may drain the effusion more slowly.

• #3 Alternative Intervention For Pericardial Effusion – Journal of Updates in Cardiovascular Medicine

  https://www.jucvm.com/articles/alternative-intervention-for-pericardial-effusion/doi/ejcm.15.00231

  Pericardial effusion is defined as the increase in the fluid levels between pericardial sheets. […] Therefore it requires close follow-up and primary treatment. There are many treatment approaches. It can be treated with pericardiocentesis needle and catheter, surgical pericardial window opening with subxiphoidal approach and left anterior thoracotomy, pericardiectomy with open thoracotomy and video thoracoscopic pericardiectomy assists (VATS) can also be applied. […] Nowadays especially for recurrent PE less invasive procedures are becoming more popular than open surgery. […] VATS method should be considered in elective cases which pericardiocentesis cannot be drained, effusion with fibrinous formation, treatment of posterior side effusions. VATS method is recommended especially in patients with pericardial effusion accompanied by pleural and lung disease. […] VATS method provides good field vision, opportunities to get a sample of tissue and less postoperative pain. Because all of this result VATS treatment of pericardial effusion can be used safely and effectively.

• #3 Management of Pericardial Effusions – When to Intervene, and How? – Canadian Association of Thoracic Surgeons

  https://www.canadianthoracicsurgeons.ca/2020/09/22/management-of-pericardial-effusions-when-to-intervene-and-how/

  5. Surgical pericardiotomy and drainage is recommended in the following cases: Patients with surgical tamponade (i.e. secondary to aortic dissection or post-infarction myocardial rupture) due to risk of exacerbating the dissection or rupture after rapid pericardial decompression and restoration of systemic arterial pressure with percutaneous techniques, Recurrent and/or loculated pericardial effusions, If biopsy of the pericardium is required for diagnostic purposes, Patients on anticoagulant therapy, or those with uncorrected coagulopathy, and/or thrombocytopenia (platelet count 50,000/mm3). […] 6. Surgical approach: both VATS and subxiphoid pericardial window have similar efficacy. Choice of surgical technique may vary based on surgeon experience, and patient factors including hemodynamic status (positioning and need for single-lung ventilation for the VATS approach may impede emergent access), as well as the need to perform concurrent procedures such as lung/pleural biopsies or drainage of concurrent pleural effusions (facilitated by a VATS approach).

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