Study of Etiological Profile, Clinical Profile and Short Term Outcome of Patients Presenting with Pericardial Effusion in a Tertiary Care Center, Nepal

Abstract

Introduction: Pericardial effusion is one of the common cardiac problems in our part of the world and adds burden to the health and economy of the country, as it is associated with high risk of morbidity and mortality. Our objective of the study was to determine the etiological spectrum of pericardial effusion, their clinical presentations and complications and assessing the usefulness of echocardiographic features of effusion in helping to determine the etiology. Methods: A cross-sectional observational prospective study of 63 patients with diagnosis of pericardial effusion was enrolled in the study. Pericardial effusion was diagnosed by echocardiography and pericardiocentesis was done in the cardiac catheterization room. Patients were followed up 3 monthly for 1 year and reassessed clinically and by echocardiography. Results: Patients presenting with pericardial effusion belonged to the age group of 8 to 88 years. The most common etiology was tuberculosis (36.5%) followed by malignancy (19%) and idiopathic/Viral (12.6%). Among malignancies, carcinoma lung was the most common cause followed by lymphoma. Pericardiocentesis was done in 46 patients (73%) and the approach was subxiphoid. The procedure-related complications were in 4 patients (6.3%) and there was no death as a consequence of the procedure. The total mortality was 12 (19%) with in-hospital death of 6 patients (9.5%). Conclusions: The study showed tuberculosis as the most common cause of pericardial effusion in developing countries like Nepal and as a cause of cardiac tamponade in contrast to the studies from the developed world where malignancy remains the leading cause.

Pericardial effusion in children at tertiary national referral hospital, Addis Ababa, Ethiopia: a 7-year institution based review

“…This is in harmony with previous reports from developing countries [ 8 , 15 , 21 ]. This contrasts with studies from other developing countries where mycobacterium tuberculosis was the common etiologic agent [ 9 – 11 , 22 , 23 ]. Whereas Ethiopia is a TB endemic country our findings should be interpreted in light of the short duration of an illness among our study subjects with a median duration of illness of about two weeks.…”

“…This is similar to other studies [ 10 , 21 ]. However, a reverse was documented in another study [ 11 ]. In this study, significant number of deaths happened at home after hospital discharge and majority had pericardiocentesis done earlier, it could be due to recollection and a missed opportunity for life saving pericardiocentesis.…”

“…Half of PE cases are idiopathic in developed settings while the remaining are caused by infectious, cancer, iatrogenic and inflammatory etiologies [ 2 – 6 ]. PE is largely of infectious origin in developing countries, mostly tuberculosis (TB) and bacterial etiologies like staphylococcus [ 7 – 11 ].…”

Clinical profile of patients admitted with pericardial effusion in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

“…Similar to the study, the most common presenting symptom in our study was breathlessness in 85% followed by tachycardia in 56% of the patient. Study done by Khanal, R. et al 9 showed most common clinical feature shortness of breath (95%) followed by tachycardia (63.4%).…”