We sought to study the clinical presentation, etiology and outcomes in patients with pericardial effusion requiring pericardiocentesis in our institution.
Medical records of all patients with pericardial effusion who required pericardiocentesis at Coney Island Hospital from July 1, 1997 to June 30, 2002 were reviewed for above data.
Total number of patients were 29 (M:F=12:17). The age ranged from 32-92 years. The presenting symptom was dyspnea in 17 patients, chest pain in 7 patients, generalized weakness in 3 patients, syncope/near syncope in 3 patients, and cough in 3 patients. Diagnosis of pericardial effusion on initial evaluation was correctly made in only 13/29[45%] patients. All patients with correct initial diagnosis of pericardial effusion were discharged from hospital. When diagnosis of pericardial effusion was not made on initial evaluation, 4 patients died within 24 hours. In 15/29[52%], etiology of pericardial effusion was established during hospital stay. Carcinoma lung-6patients, Carcinoma Breast-3patients, Dressler syndrome-2patients, chronic renal failure-1patient, Rheumatoid arthritis-1patient. 2 patients had hemopericardium following complicated acute myocardial infarction. 14/29[48%] patients had no etiology identified as the cause of pericardial effusion. 15/29[52%] patients with established etiology for pericardial effusion had mean survival of >23 months, with 1 and 2 year survival of 43% and 43% respectively. Patients with no etiology identified as cause of pericardial effusion had mean survival >50 months, with 1 and 2 year survival of 93% and 85% respectively.
Dyspnea and chest pain were the most common symptoms in patients with significant pericardial effusion. Carcinoma was the leading identified cause. Even in presence of significant pericardial effusion, diagnosis is often not made during the initial evaluation and such patients have a high early mortality. Patients with pericardial effusion with unknown etiology had better long-term survival than those with established etiology.
A high index of suspicion is needed during the initial evaluation of patients with unexplained dyspnea and chest pain in order to promptly diagnose pericardial effusion. Idiopathic pericardial effusion even in patients requiring pericardiocentesis carries a good prognoses.
V. Rupanagudi, None.