Cardiac Tamponade/ therapy

IJCS

Editorial

The Importance of Early Diagnosis and Treatment for Pericardial Effusion and Cardiac Tamponade

Carlos Aurélio dos Santos Aragão et al. Vera Maria Cury Salemi

Pericardial effusion has several etiologies, such as primary pericardial diseases, cardiac surgery, trauma and systemic conditions, including hypothyroidism, renal failure, chronic neoplastic infiltration, autoimmune inflammation, systemic lupus erythematosus, and rheumatoid arthritis.’ Queiroz et al., published an interesting paper on 254 patients with pericardial effusion at a quaternary institution, 40.4% with severe pericardial effusion and 44.1% with cardiac tamponade. Retrospective cohorts of critically ill patients are rare in the literature. The most frequent etiology was idiopathic, but postoperative, neoplasia, and postinterventional procedures were also common. Although the main etiology is idiopathic in developed countries, infectious causes are prominent in developing countries, such as tuberculosis, which reaches a frequency above 60%. During the current COVID-19 pandemic, SARS-CoV-2 is of great importance in etiological investigation.

In Queiroz et al., pericardial effusion was diagnosed by echocardiography, a widely available and inexpensive method that can be performed at bedside. In addition to clinical and epidemiological aspects, Doppler echocardiography, magnetic resonance imaging, nuclear medicine tests, and laboratory analysis of the pericardial fluid could provide additional information about the etiology. However, the gold standard diagnostic exam is pericardial biopsy, which is indicated for diagnostic investigation in patients with persistent pericarditis refractory to clinical treatment and no definitive diagnosis.

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IJCS

Original Article

Pericardial Effusion and Cardiac Tamponade: Etiology and Evolution in the Contemporary Era

Claudio Martins de Queiroz et al. Juliano Cardoso Felix Ramires Barbara Ianni … Viviane Tiemi Hotta Charles Mady Paula de Cassia Buck Ricardo Ribeiro Dias Luciano Nastari Fábio Fernandes

Abstract

Background:

Pericardial effusion is a relatively common finding and can progress to cardiac tamponade; etiological diagnosis is important for guiding treatment decisions. With advances in medicine and improvement in the social context, the most frequent etiological causes have changed.

Objectives:

To evaluate the clinical and laboratory characteristics, etiology, and clinical course of patients with pericardial effusion and cardiac tamponade.

Materials and methods:

Patients with pericardial effusion classified as small ( 20 mm) were included. Data from the clinical history, physical examination, laboratory tests, and complementary tests were evaluated in patients with pericardial effusion and cardiac tamponade. The significance level was set at 5%.

Results:

A total of 254 patients with a mean age of 53.09 ± 17.9 years were evaluated, 51.2% of whom were female. A total of 40.4% had significant pericardial effusion (> 20 mm). Pericardial tamponade occurred in 44.1% of patients. Among pericardial effusion patients without tamponade, the most frequent etiologies were: idiopathic (44.4%) and postsurgical (17.6%), while among those with tamponade, the most frequent etiologies were postsurgical (21.4%) and postprocedural (19.6%). The mean follow-up time was 2.2 years. Mortality was 42% and 23.2 in those with and without tamponade, respectively (p=0.001).

Conclusions:

There is an etiological difference between pericardial effusion patients with and without cardiac tamponade. An idiopathic etiology is more common among those without tamponade, while postinterventional/postsurgical is more common among those with tamponade. The tamponade group had a higher mortality rate.