Pericardial Effusion: Acute Management and Therapy
Author : A.A. Akis, C. M. Gultom, D. D. Miranti, M. A. P. Prabowo, N. R. Simatupang, A. F. Chandranegara, H.
Upload Date : 19-04-2018
Introduction: A pericardial effusion occurs when a significant amount of fluid fills the pericardial space. When pericardial fluid accumulates slowly, the pericardium can expand to accommodate as much as 2 liters of fluid. However, when acute, only a small volume can increase intrapericardial pressures, resulting in clinical symptoms.
Case Illustration: 21 year old male admited to ER with chief complaint of shortness of breath, fatigue and cough with sputum since one day before. Blood test revealed tromboytosis. Chest x-ray revealed cardiomegaly and left pleural effusion. Echocardiogram revealed pericardial effusion with sign of impending tamponade, decreased systolic function of left ventricle, decreased systolic function of right ventricle, and restrictive dyastolic function of left ventricle. E wave variation showed more than 25%.
Discussion: Pericardiocentesis was performed on the first day and aspirations were performed daily for 5 days. Pericardial fluid was cultured and consist of mesothelium cell, macrofag, leucocyte and no sign of malignancy. One ampule of dexamethasone was administrated before pericardiocentesis was removed.Bisoprolol, ceftriaxone, furosemmide, spironolactone and ibuprofen was given as a treatment during hospitalization.
Patient shows clinical improvement and was discharged in a stable condition.
Pericardiocentesis alone may be necessary for the resolution of large effusions, but recurrences are also common, and pericardiectomy or less invasive options (i.e. pericardial window) should be considered whenever fluid reaccumulates, becomes loculated or biopsy material is required
Conclusion: There are no proven effective medical therapies to reduce an isolated effusion. In the absence of inflammation, NSAIDs, colchicine and corticosteroids are generally not effective. For this patient, the best treatment is intervention therapy such as pericardiocentesis. Further more, the etiology of pericardial effussion have to be elaborated.
KEYWORDS : Pericardial effusion, pericardiocentesis, therapy
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