From the Guidelines
Pericardial effusion in the elderly is most commonly caused by malignancy, cardiovascular diseases, and infections, with malignancy being a leading cause in this age group, as evidenced by studies such as 1. The causes of pericardial effusion in the elderly can be multifaceted, including:
- Malignancy, particularly lung, breast, lymphoma, and metastatic disease, which can invade the pericardium and cause fluid accumulation 1
- Cardiovascular causes, including heart failure, myocardial infarction complications, and post-cardiac surgery inflammation
- Infections such as viral pericarditis, tuberculosis, and bacterial infections, though viral causes are less common in older adults than in younger populations
- Autoimmune disorders like rheumatoid arthritis, lupus, and scleroderma, which may cause pericardial inflammation and effusion
- Uremia in patients with kidney failure, as well as medications including certain chemotherapy agents, amiodarone, and hydralazine
- Hypothyroidism, which can lead to slow accumulation of pericardial fluid
- Radiation therapy to the chest for cancer treatment, which may cause acute or chronic pericardial inflammation
- Trauma, aortic dissection, and iatrogenic causes from procedures like central line placement
According to the most recent and highest quality study, malignant pericardial effusion is a significant concern in the elderly, with lung cancer, breast cancer, leukemia, and lymphoma being common causes 1. The diagnosis and management of pericardial effusion should be targeted at the underlying cause, with pericardiocentesis and drainage of the effusion being considered in symptomatic cases or when empiric anti-inflammatory drugs are not successful 1. In cases of malignant pericardial effusion, factors such as age, platelet count, and presence of malignant cells in the effusion can affect prognosis, highlighting the need for prompt evaluation and treatment 1.
From the Research
Causes of Pericardial Effusion in the Elderly
The causes of pericardial effusion in the elderly can be attributed to various factors, including:
- Idiopathic cases 2
- Autoimmune diseases 2
- Malignancies 2, 3
- Metabolic disorders 2
- Renal disease 4, 5
- Specific pericardial infections, such as tuberculous and purulent pericarditis, although less common in the elderly 6
- Neoplastic pericardial effusion, which can be a challenge to manage due to the risk of reaccumulation of pericardial fluid 3
Etiologic Spectrum and Clinical Course
Studies have shown that the etiologic spectrum and clinical course of pericardial effusion in elderly patients are generally similar to those in younger patients 6. However, persistence of effusion is more common in elderly patients 6. The prognosis of pericardial effusions largely depends on the underlying etiologies, with metastatic spread to the pericardium having an ominous prognosis 2.
Management and Treatment
The management and treatment of pericardial effusion in the elderly should be based on the underlying cause and clinical presentation. Medical therapy should be offered to patients with elevation of inflammatory markers, and pericardial drainage may be necessary in cases with hemodynamic compromise 2, 3. The selection of the pericardial drainage procedure depends on the etiology of the effusion, with simple pericardiocentesis usually sufficient in patients with acute idiopathic or viral pericarditis, and surgical drainage necessary for purulent pericarditis 3.