Echocardiographic Observations Regarding Pericardial Effusions Associated with Cardiac Disease

doi:10.1378/chest.78.5.736

Chest

Volume 78, Issue 5, November 1980, Pages 736-740

https://doi.org/10.1378/chest.78.5.736 Get rights and content

Cardiac disease associated with congestive heart failure was found to be the most common cause (22 of 76) of pericardial effusion in patients referred for echocardiography. Parameters of left heart function were markedly abnormal in these patients with congestive heart failure and pericardial effusion, but were not significantly different from a group of patients with congestive heart failure without pericardial effusion. Clinical findings consistent with cardiac decompensation also failed to discern between these two groups. Nonetheless, patients with congestive heart failure with pericardial effusion had significantly larger right ventricular internal dimensions than those without effusion. Patients with pericardial effusion related to congestive heart failure (P < .01), heart disease without congestive heart failure (P < 0.001) and those patients post recent myocardial infarction (P < 0.05) had significantly larger right ventricular internal dimensions in diastole than normal subjects. Patients with pericardial effusions related to recent open heart surgery, idiopathic pericarditis or of miscellaneous causes had normal right ventricular internal dimensions. It is likely that right ventricular dilatation indicates abnormal volume/pressure relationships of the right heart and that this abnormality, through alterations in venous and lymphatic drainage, underlies the accumulation of pericardial effusion in these patients with heart disease with or without congestive heart failure.

Section snippets

METHODS

Seventy-six consecutive echocardiographic studies showing definite pericardial effusions were examined. Detailed chart review was performed to assess the most likely cause for effusion in each patient. The most likely etiology for effusion, size of effusion, right ventricular internal dimension in diastole, left ventricular internal dimension in diastole, and patient's age were tabulated. Furthermore, right ventricular end-diastolic dimension was measured in 15 age-matched normal patients to

RESULTS

The etiologies for the pericardial effusions in our 76 patients are summarized in Table 1. In addition, their ages, right ventricular internal dimension in diastole, left ventricular internal dimension in diastole, and the size of their effusions are summarized. The 22 patients with heart disease and congestive heart failure includes five patients who had predominantly right-sided heart failure with relatively normal left ventricular volume and contraction factors and 17 patients who had

DISCUSSION

Our observations are consistent with the prior reports that heart disease, especially when accompanied by congestive heart failure, is the most prevalent abnormality associated with pericardial effusion in those patients who have been referred for echocardiography.1, 2 This prevalence is biased to some degree in that cardiologists are the main referral source to our noninvasive facility. When Vignola and colleagues⁹ analyzed the etiology of moderate and large pericardial effusions, the number

ACKNOWLEDGMENT

We gratefully acknowledge the technical assistance of Dale Gindlesperger.

REFERENCES (18)

M Berger et al.
Pericardial effusion diagnosed by echocardiography
Chest
(1978)
WL Winters et al.
Pericardial effusion in congestive heart failure
Dis Chest
(1961)
H Feigenbaum
Echocardiographic diagnosis of pericardial effusion
Am J Cardiol
(1970)
RP Martin et al.
Localization of pericardial effusion with wide angle phased array echocardiography
Am J Cardiol
(1978)
PA Vignola et al.
Correlation of echocardiographic and clinical findings in patients with pericardial effusion
Am J Cardiol
(1976)
JP Holt
The normal pericardium
Am J Cardiol
(1970)
AJ Miller et al.
The production of acute pericardial effusion
Am J Cardiol
(1971)
M Hollenberg et al.
Lymph flow and ¹³¹I-albumin resorption from pericardial effusions in man
Am J Cardiol
(1969)
J Isner et al.
Right ventricular infarction complicating left ventricular infarction secondary to coronary heart disease
Am J Cardiol
(1978)

There are more references available in the full text version of this article.

Cited by (10)

Prognostic impact of small pericardial effusion in acute heart failure
2022, American Journal of the Medical Sciences
Citation Excerpt :
Previous studies showed that presence or development of SPE was associated with adverse events in patients with lung cancer,⁶ acute ischemic stroke,⁷ human immunodeficiency virus infection,⁸ and pneumonia,⁹ as well as in heart transplant patients¹⁰ and patients undergoing hip fracture surgery.¹¹ Although the prevalence of SPE varied from 12 to 20% in patients with heart failure,¹²,¹³ only one study has examined the association between SPE and prognosis in CHF,¹⁴ and only one study has investigated the prognostic value of SPE in AHF.¹⁵ Therefore, the present study aimed to examine the frequency and prognostic relevance of SPE in AHF.
The relationship between small pericardial effusion (SPE) and outcomes has not been well studied in patients with heart failure. Therefore, we aimed to investigate the prevalence and importance of SPE in acute heart failure (AHF).
A total of 398 hospitalized patients with AHF were retrospectively reviewed. Patients’ baseline demographic, clinical, echocardiographic, and laboratory characteristics were noted. SPE was defined as the presence of a pericardial effusion <10 mm. The primary outcome was one-year mortality.
SPE was noted in 54 (13.6%) of the patients. Mortality at one year was greater for patients with a small effusion compared with those without SPE (44.4 vs. 11.4%, respectively; p < 0.001), and the one-year mortality rate for the whole group was 15.8%. Age (HR = 1.12, 95% CI 1.054–1.854, p = 0.024), N-terminal pro-B-type natriuretic peptide >4800 pg/ml (HR = 1.628, 95% CI 01.102–4.805, p = 0.001), left ventricular ejection fraction <30% (HR = 1.878, 95% CI 1.154–4.524, p = 0.001), and presence of SPE (HR = 1.567, 95% CI 1.122–2.991, p = 0.005) were independent predictors of one-year mortality on multivariate analysis.
The presence of SPE on admission was an independent predictor of one-year mortality in AHF.
Pericardial and pleural effusions in congestive heart failure - Anatomical, pathophysiologic, and clinical considerations
2009, American Journal of the Medical Sciences
Citation Excerpt :
Presumptively, a larger right ventricular diastolic internal dimension may signify a history of higher right-sided filling pressures in patients with pericardial effusion when compared with patients with no effusion. Unfortunately, no hemodynamic data was collected in that study.3 In patients with elevated left-sided filling pressures, a pulmonary artery wedge pressure of >18 mm Hg is strongly associated with formation of pleural effusions.30
Transudative pleural and pericardial effusions are not uncommon in patients with congestive heart failure. Pericardial effusion forms only with elevation of the right-sided filling pressure in the heart. In patients with biventricular failure, there is no evidence that elevated left-sided pressure, in the absence of elevated right-sided pressure, can cause a pericardial effusion. Pleural effusion forms with acute elevation of the right-sided or the left-sided filling pressure in the heart. In patients with congestive heart failure, elevated right-sided filling pressures are less common than elevated left-sided filling pressures, thus, explaining a lower prevalence of pericardial than pleural effusions. Pleural effusions in patients with congestive heart failure are typically bilateral. However, a unilateral pleural effusion is more commonly seen on the right side. Although multiple theories attempt to explain the right-sided preponderance of pleural effusion, to date, no mechanism has been universally accepted or experimentally proven.
Critical Cardiologic Considerations in the Cancer Patient
1988, Critical Care Clinics
Aggressive treatment modalities for patients with cancer are often associated with complications or side effects, fre¬quently involving the cardiovascular system. Longer sur¬vival of cancer patients can lead to the development of re¬lated or unrelated cardiac problems. This article reviews the major cardiac entities necessitating transfer of cancer patients to intensive care facilities and addresses specific management strategies.
Incidence and significance of pericardial effusion in acute myocardial infarction as determined by two-dimensional echocardiography
1986, Journal of the American College of Cardiology
To determine the incidence and clinical significance of pericardial effusion after acute myocardial infarction, two-dimensional echocardiography was serially performed in 66 consecutive patients. Pericardial effusion was observed in 17 (26%); the effusion was small in 13 patients, moderate in 3 and large with signs of cardiac tamponade in 1. In this patient, two-dimensional echocardiography strongly suggested myocardial rupture. The observation of pericardial effusion was not associated with age, sex, previous myocardial infarction, atrial fibrillation or treatment with heparin. It was more often a complication of anterior than of inferior acute infarction. Patients with pericardial effusion had higher peak levels of creatine kinase and lactic dehydrogenase and a higher wall motion score index. More patients with pericardial effusion had congestive heart failure or ventricular arrhythmias, developed a ventricular aneurysm or died within 1 year after their infarction.
In conclusion, pericardial effusion is frequently visualized by two-dimensional echocardiography after acute myocardial infarction and its presence is associated with an increased occurrence of complications and cardiac death.
Pleural and pericardial effusions in cancer patients
1985, Current Problems in Cancer
Incidence of pericardial effusions in acute myocardial infarctions
1984, Chest

View all citing articles on Scopus

: Manuscript received October 15; revision accepted December 17.

View full text

Chest

Echocardiographic Observations Regarding Pericardial Effusions Associated with Cardiac Disease

Section snippets

METHODS

RESULTS

DISCUSSION

ACKNOWLEDGMENT

Chest

Dis Chest

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol