From the Guidelines
Pericardiocentesis with prolonged pericardial drainage is the recommended treatment for symptomatic pericardial effusion without evidence of inflammation or when empiric anti-inflammatory drugs are not successful, as stated in the 2015 ESC guidelines 1. The treatment of pericardial effusion should be targeted at the underlying cause as much as possible, with about 60% of cases associated with a known disease, and the essential treatment being that of the underlying disease 1. When pericardial effusion is associated with pericarditis, management should follow that of pericarditis, and when a pericardial effusion becomes symptomatic without evidence of inflammation or when empiric anti-inflammatory drugs are not successful, drainage of the effusion should be considered 1. Some key points to consider in the treatment of pericardial effusion include:
- Pericardiocentesis alone may be necessary for the resolution of large effusions, but recurrences are also common 1
- Pericardiectomy or less invasive options, such as a pericardial window, should be considered whenever fluid reaccumulates, becomes loculated, or biopsy material is required 1
- In the absence of inflammation, NSAIDs, colchicine, and corticosteroids are generally not effective in reducing an isolated effusion 1 The primary goal of treatment is to prevent hemodynamic compromise and life-threatening cardiac tamponade, while also addressing the underlying cause of the pericardial effusion.
From the Research
Treatment Options for Pericardial Effusion
The treatment for pericardial effusion depends on various factors, including the size of the effusion, the presence of symptoms, and the underlying cause. Some key considerations include:
- The size and hemodynamic impact of the effusion: larger effusions are at a higher risk of progressing to cardiac tamponade 2, 3
- The presence of inflammation or pericarditis: this may require specific treatment, such as anti-inflammatory medications 2, 4
- The underlying cause of the effusion: treatment should be targeted at the underlying cause whenever possible 2, 3, 5
Medical Management
Medical management options for pericardial effusion include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) for uncomplicated cases 4
- Colchicine for refractory cases or as initial therapy in recurrences 6, 4
- Systemic corticosteroids for immune-mediated etiologies or refractory cases 4
- Aspirin for pericarditis complicating acute myocardial infarction 4
Invasive Management
Invasive management options for pericardial effusion include:
- Pericardiocentesis for large effusions or those causing cardiac tamponade 2, 3, 4
- Pericardial biopsy for cases with recurrent cardiac tamponade or persistence without a defined etiology 2
- Pericardiectomy or creation of a pericardial window for recurrent cases or those with malignant effusions 2, 3, 4
Conservative Approach
A conservative approach may be reasonable for asymptomatic patients with large, chronic, idiopathic pericardial effusions without evidence of inflammation 5. However, this approach should be individualized and guided by the specific circumstances of each case.