Complications
Cardiac tamponade is a life-threatening complication of acute pericarditis. These patients require urgent pericardiocentesis.
Accumulation of transudate, exudate, or blood in the pericardial sac can occur due to pericardial inflammation. Increased intrapericardial pressure from the pericardial effusion (particularly one in which the fluid accumulation occurs over a relatively short time) can compress the cardiac chambers leading to cardiac tamponade.[1][13][42]
Pericardiocentesis is also indicated for suspected purulent pericarditis, high suspicion of neoplastic pericarditis, a large or symptomatic pericardial effusion in a patient with non-purulent pericarditis, purulent pericarditis, and a high suspicion of tumour. The effusion should be drained dry and the fluid analysed for glucose, protein, and lactate dehydrogenase. Cell count, microscopy, bacterial and/or viral culture, and cytological examination should be performed.
In some situations, pericardiocentesis cannot be performed from a percutaneous approach and surgical drainage is required. A sub-xiphoid approach is generally successful and has <1% complication rate and 8% rate of recurrence of effusion.
Most cases occur within 3 to 12 months after the pericardial insult. It is a relatively rare complication[80] and in developed countries is most frequently caused by prior cardiac surgery (prevalence of 0.2% to 0.3%), radiotherapy (4% of patients with radiation for mediastinal Hodgkin's disease), and idiopathic pericarditis. Tuberculosis is the main cause in developing countries.
In the healing process of acute, fibrinous, serofibrinous, or chronic pericardial effusion, the pericardial cavity can be completely replaced by granulation tissue. This results in a dense scar that encases the heart and interferes with ventricular filling. Surgical pericardial resection is the definitive treatment.[1][2][12][13][81]
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