Malignant Pericardial Effusion and Cardiac Tamponade (Cardiac and Pericardial Symptoms)

Abstract

A malignant pericardial effusion and a cardiac tamponade are known life-threatening complications in cancer patients. An early recognition and a prompt treatment may dramatically relieve patients of symptoms and decrease a short-term risk of death from the effusion. Although the pericardial involvement by malignancy is the leading cause, other etiological factors need exclusion before the final treatment strategy is determined. The treatment of malignant pericardial effusions must be individualized with a consideration given to the patient’s condition and tumor type, the success rates and risks of the various treatment modalities, and their local availability and expertise. The initial relief of symptoms is achieved, in most cases, with a percutaneous pericardiocentesis. A subsequent drainage of the pericardial effusion with an indwelling catheter and a local sclerotherapy and/or chemotherapy alleviates the effusion without recurrence in most of the patients. These procedures are associated with low morbidity and mortality and are preferred in the initial management of symptomatic malignant pericardial effusions. Recommended therapy for a recurrent pericardial effusion include: a repetition of pericardiocentesis and intrapericardial instillation of agents with both sclerosing and cytostatic activity, a percutaneous balloon pericardiotomy, or a surgical treatment.