Skip to main content
SpringerLink
Log in

Pericardial Effusion and Cardiac Tamponade in the New Millennium

  • Pericardial Disease (AL Klein, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this paper is to review current approaches to the diagnosis and treatment of pericardial effusions and cardiac tamponade.

Recent Findings

Recent recommendations from the American Society of Echocardiography and the European Society of Cardiology have refined our approaches to the patient with pericardial effusion and cardiac tamponade, but significant knowledge gaps remain. New diagnostic and triage strategies have been proposed, and recent data have advanced our ability to assess the presence and size of a pericardial effusion, assess its hemodynamic impact, and establish its cause.

Summary

Despite these recent findings, there is a paucity of evidence-based data to guide the management of pericardial effusion and cardiac tamponade. While the first-line function of echocardiography in managing these disorders is unquestioned, there are increasing niche roles for multimodality imaging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

Papers of Particular Interest, Published Recently, Have Been Highlighted as: •  Of importance, •• Of major Importance

  1. • Adler Y, Charron P, Imazio M, Badano L, Baron-Esquivias G, Bogaert J, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: the Task force for the diagnosis and management of pericardial diseases of the European Society of Cardiology (ESC) endorsed by: the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36:2921–64. An exhaustive, authoritative document offering guidelines and recommendations (most representing a consensus of experts and/or small studies, retrospective studies, and registries) for all manifestations of pericardial disease.

    Article  PubMed  Google Scholar 

  2. Hoit BD. Diagnosis and treatment of pericardial effusion. www.uptodate.com. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on 3/23/17.) Copyright © 2016 UpToDate, Inc. For more information visit www.uptodate.com.

  3. • Imazio M, Adler Y. Management of pericardial effusion. Eur Heart J. 2013;34:1186–97. A critical evaluation of the pathophysiology, clinical presentation diagnosis, treatment, and follow-up of pericardial effusions.

    Article  PubMed  Google Scholar 

  4. Permanyer-Miralda G, Sagrista-Sauleda J, Soler-Soler J. Primary acute pericardial disease: a prospective series of 231 consecutive patients. Am J Cardiol. 1985;56:623–30.

    Article  CAS  PubMed  Google Scholar 

  5. Sagrista-Sauleda J, Merce J, Permanyer-Maralda G, Soler-Soler J. Clinical clues to the causes of large pericardial effusions. Am J Med. 2000;109:95–101.

    Article  CAS  PubMed  Google Scholar 

  6. Corey GR, Campbell PT, VanTrigt P, Kenney RT, O’Connor CM, Sheikh KH, et al. Etiology of large pericardial effusion. Am J Med. 1993;95:209–13.

    Article  CAS  PubMed  Google Scholar 

  7. Levy PY, Corey R, Berger P, Habib G, Bonnet JL, Levy S, et al. Etiologic diagnosis of 204 pericardial effusion. Medicine (Baltimore). 2003;82:385–91.

    Article  Google Scholar 

  8. • Ma W, Liu J, Chen S, Chen S, Zheng Y, Ye S, et al. Causes of moderate to large pericardial effusion requiring pericardiocentesis in 140 Han Chinese patients. Herz. 2012;37:183–7. A contemporary review of the clinical characteristics and etiologies of moderate to large pericardial effusions that required drainage. Malignancy, infection, and iatrogenic were the three leading causes.

    Article  CAS  PubMed  Google Scholar 

  9. Seferovic PM, Ristic AD, Imazio M, Maksimovic R, Simeunovic D, Trinchero R, et al. Management strategies in pericardial emergencies. Herz. 2006;31:891–900.

    Article  PubMed  Google Scholar 

  10. Kuvin JT, Harati NA, Pandian NG, Bojar RM, Khabbaz KR. Postoperative cardiac tamponade in the modern surgical era. Ann Thorac Surg. 2002;74:1148–53.

    Article  PubMed  Google Scholar 

  11. •• Meurin P, LeLay-Kubas S, Pierre B, Pereira H, Pavy B, Iliou MC, et al. Colchicine for post-operative pericardial effusion. J Am Coll Cardiol. 2015;66:1198–9. A letter which describes the preliminary results of the POPE-2 study. In patients with a moderate to large pericardial effusion persisting one week after cardiac surgery, colchicine had no significant effect on the size of the effusion.

    Article  PubMed  Google Scholar 

  12. Freeman GL, LeWinter MM. Pericardial adaptations during chronic cardiac dilation in dogs. Circ Res. 1984;54:294–300.

    Article  CAS  PubMed  Google Scholar 

  13. •• Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr. 2013;26:965–1012. A detailed, well-illustrated expert consensus statement from the ASE offering recommendations for integrated multimodality imaging in all manifestations of pericardial disease.

    Article  PubMed  Google Scholar 

  14. Verhaert D, Gabriel RS, Johnston D, Lytle BW, Desai MY, Klein AL. The role of multimodality imaging in the management of pericardial diseases. Circ Cardiovasc Imaging. 2010;3:333–43.

    Article  PubMed  Google Scholar 

  15. Shabetai R. Pericardial effusion: haemodynamic spectrum. Heart. 2004;90:255–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Brown J, MacKinnon D, King A, Vanderbush E. Elevated arterial blood pressure in cardiac tamponade. N Engl J Med. 1992;327:463–6.

    Article  CAS  PubMed  Google Scholar 

  17. Reddy PS, Curtiss EI, O'Toole JD, Shaver JA. Cardiac tamponade: hemodynamic observations in man. Circulation. 1978;58:265–72.

    Article  CAS  PubMed  Google Scholar 

  18. Cogswell TL, Bernath GA, Raff H, Hoffmann RG, Klopfenstein HS. Total peripheral resistance during cardiac tamponade: adrenergic and angiotensin roles. Am J Phys. 1986;251:R916–22.

    CAS  Google Scholar 

  19. Sagrista-Sauleda J, Angel J, Sambola A, Alguersuari J, Permanyer-Miralda G, Soler-Soler J. Low-pressure cardiac tamponade: clinical and hemodynamic profile. Circulation. 2006;114:945–52.

    Article  PubMed  Google Scholar 

  20. Vaska K, Wann LS, Sagar K, Klopfenstein HS. Pleural effusion as a cause of right ventricular diastolic collapse. Circulation. 1992;86:609–17.

    Article  CAS  PubMed  Google Scholar 

  21. • Ristic AD, Imazio M, Adler Y, Anastasakis A, Badano LP, Brucato A, et al. Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2014;35:2279–84. A proposal for a step-wise scoring system based on the etiology, clinical presentation and imaging of pericardial effusions that identifies high risk patients requiring urgent pericardiocentesis and those patients that should be transferred to hospitals specializing in pericardial disease.

    Article  PubMed  Google Scholar 

  22. Himelman RB, Kircher B, Rockey DC, Schiller NB. Inferior vena cava plethora with blunted respiratory response: a sensitive echocardiographic sign of cardiac tamponade. J Am Coll Cardiol. 1988;12:1470–7.

    Article  CAS  PubMed  Google Scholar 

  23. Singh S, Wann LS, Klopfenstein HS, Hartz A, Brooks HL. Usefulness of right ventricular diastolic collapse in diagnosing cardiac tamponade and comparison to pulsus paradoxus. Am J Cardiol. 1986;57:652–6.

    Article  CAS  PubMed  Google Scholar 

  24. Gillam LD, Guyer DE, Gibson TC, King ME, Marshall JE, Weyman AE. Hydrodynamic compression of the right atrium: a new echocardiographic sign of cardiac tamponade. Circulation. 1983;68:294–301.

    Article  CAS  PubMed  Google Scholar 

  25. Leimgruber PP, Klopfenstein HS, Wann LS, Brooks HL. The hemodynamic derangement associated with right ventricular diastolic collapse in cardiac tamponade: an experimental echocardiographic study. Circulation. 1983;68:612–20.

    Article  CAS  PubMed  Google Scholar 

  26. Merce J, Sagrista-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J. 1999;138:759–64.

    Article  CAS  PubMed  Google Scholar 

  27. Hoit BD, Fowler NO. Influence of acute right ventricular dysfunction on cardiac tamponade. J Am Coll Cardiol. 1991;18:1787–93.

    Article  CAS  PubMed  Google Scholar 

  28. Hoit BD, Gabel M, Fowler NO. Cardiac tamponade in left ventricular dysfunction. Circulation. 1990;82:1370–6.

    Article  CAS  PubMed  Google Scholar 

  29. Chuttani K, Tischler MD, Pandian NG, Lee RT, Mohanty PK. Diagnosis of cardiac tamponade after cardiac surgery: relative value of clinical, echocardiographic, and hemodynamic signs. Am Heart J. 1994;127:913–8.

    Article  CAS  PubMed  Google Scholar 

  30. Hoit BD, Shaw D. The paradoxical pulse in tamponade: mechanisms and echocardiographic correlates. Echocardiography. 1994;11:477–87.

    Article  CAS  PubMed  Google Scholar 

  31. Seferović PM, Ristić AD, Maksimović R, Tatic V, Ostojic M, Kanjuh V. Diagnostic value of pericardial biopsy: improvement with extensive sampling enabled by pericardioscopy. Circulation. 2003;107:978–83.

    Article  PubMed  Google Scholar 

  32. Maisch B, Ristić AD, Pankuweit S. Intrapericardial treatment of autoreactive pericardial effusion with triamcinolone; the way to avoid side effects of systemic corticosteroid therapy. Eur Heart J. 2002;23:1503–8.

    Article  CAS  PubMed  Google Scholar 

  33. Ben-Horin S, Bank I, Shinfeld A, Kachel E, Guetta V, Livneh A. Diagnostic value of the biochemical composition of pericardial effusions in patients undergoing pericardiocentesis. Am J Cardiol. 2007;99:1294–7.

    Article  CAS  PubMed  Google Scholar 

  34. Tsang TS, Enriquez-Sarano M, Freeman WK, Barnes ME, Sinak LJ, Gersh BJ, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocentesis: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc. 2002;77:429–36.

    Article  PubMed  Google Scholar 

  35. • Imazio M, Belli R, Beqaraj F, et al. DRainage Or Pericardiocentesis alone for recurrent nonmalignant, nonbacterial pericardial effusions requiring intervention: rationale and design of the DROP trial, a randomized, open-label, multicenter study. J Cardiovasc Med. 2014;15:510–4. Methodology of a multicenter trial that is randomizing patients with hemodynamically significant nonmalignant, nonbacterial pericardial effusions to pericardiocentesis vs. pericardiocentesis plus prolonged drainage. The primary end-points are incidence of recurrent pericardial effusion and the need for additional pericardiocentesis or cardiac surgery at 12 months.

    Article  CAS  Google Scholar 

  36. Ziskind AA, Pearce AC, Lemmon CC, Burstein S, Gimple LW, Herrmann HC, et al. Percutaneous balloon pericardiotomy for the treatment of cardiac tamponade and large pericardial effusions: description of technique and report of the first 50 cases. J Am Coll Cardiol. 1993;21:1–5.

    Article  CAS  PubMed  Google Scholar 

  37. Mitiku TY, Heidenreich PA. A small pericardial effusion is a marker of increased mortality. Am Heart J. 2011;161:152–7.

    Article  PubMed  Google Scholar 

  38. • Frohlich GM, Keller P, Schmid F, et al. Haemodynamically irrelevant pericardial effusion is associated with increased mortality in patients with chronic heart failure. Eur Heart J. 2013;34:1414–23. In this retrospective observational study of nearly 900 patients with heart failure, the presence of a hemodynamically insignificant pericardial effusion was independently associated with a ~ 2-fold hazard of death at one year.

    Article  PubMed  Google Scholar 

  39. Sagristà-Sauleda J, Angel J, Permanyer-Miralda G, Soler-Soler J. Long-term follow-up of idiopathic chronic pericardial effusion. N Engl J Med. 1999;341:2054–9.

    Article  PubMed  Google Scholar 

  40. Hoit BD. Diagnosis and management of pericardial disease. J Intensive Care Med. 2000;15(1):14–28.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106-5038, USA

    Brian D. Hoit

Authors
  1. Brian D. Hoit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian D. Hoit.

Ethics declarations

Conflict of Interest

Brian D. Hoit declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pericardial Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hoit, B.D. Pericardial Effusion and Cardiac Tamponade in the New Millennium. Curr Cardiol Rep 19, 57 (2017). https://doi.org/10.1007/s11886-017-0867-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-017-0867-5

Keywords

Search

Navigation