Pericardial effusion

Echocardiogram Used to assess LV size, valve function, pericardial effusion, wall motion abnormalities, and ejection fraction. 

Pulsus paradoxus Exaggeration of normal variation in the pulse during respiration—the pulse becomes weaker during inhalation and stronger during exhalation characteristic of constrictive pericarditis or pericardial effusion. 

Tretinoin -naturally occurring retinoid -retinoic acid syndrome -fever -chest pain -hypoxia -pulmonary infiltrates -pleural/pericardial effusions -nausea and vomiting -mucocutaneous effects -arthralgias -headaches -increased triglycerides -xerostomia, exfoliation, chelitis... 

Minoxidil may produce serious adverse effects. It can cause pericardial effusion, occasionally progressing to tamponade it can exacerbate angina pectoris. Reserve for hypertensive patients who do not respond adequately to maximum therapeutic doses of a diuretic and 2 other antihypertensive agents. 

Pericardial effusion Pericardial effusion, occasionally with tamponade, has occurred in approximately 3% of treated patients not on dialysis, especially those with inadequate or compromised renal function. Many cases were associated with connective tissue disease, the uremic syndrome, CHF or fluid retention, but were instances in which these potential causes of effusion were not present. Observe patients closely for signs of pericardial disorder. Perform echocardiographic studies if suspicion arises. More vigorous diuretic therapy, dialysis, pericardiocentesis, or surgery may be required. If the effusion persists, consider drug withdrawal. 

Monitoring Monitor initially and periodically thereafter body weight, blood pressure, fluid, and electrolyte balance signs and symptoms of pericardial effusion ECG changes CBC alkaline phosphatase renal function tests. 

Adverse reactions may include Stevens-Johnson syndrome pericardial effusion T-wave changes rebound hypertension (following gradual withdrawal in children) decreased initial hematocrit, hemoglobin and erythrocyte counts nausea vomiting temporary edema alkaline phosphatase/serum creatinine/BUN increase, hypertrichosis. 

Severe fluid retention (manifested as pleural effusion, pericardial effusion, pulmonary edema, and ascites) and hepatotoxicity occur rarely... 

Pericardial effusion and tamponade may be seen in patients with impaired renal function who are not on dialysis. 

Oral minoxidil is a potent agent which has significant side effects including pericardial effusion leading to tamponade and angina pectoris. 

Cardiovascular system Decreased peripheral vascular resistance increased heart rate, stroke volume, cardiac output, pulse pressure high-output heart failure increased inotropic and chronotropic effects arrhythmias angina Increased peripheral vascular resistance decreased heart rate, stroke volume, cardiac output, pulse pressure low-output heart failure ECG bradycardia, prolonged PR interval, flat T wave, low voltage pericardial effusion... 

Although the two growth factors have similar effects on neutrophil counts, G-CSF is used more frequently because it is better tolerated. G-CSF can cause bone pain, which clears when the drug is discontinued. GM-CSF can cause more severe side effects, particularly at higher doses. These include fevers, malaise, arthralgias, myalgias, and a capillary leak syndrome characterized by peripheral edema and pleural or pericardial effusions. Allergic reactions may occur but are infrequent. Splenic rupture is a rare but serious complication of the use of G-CSF for PBSC. 

Fluid retention includes events such as peripheral oedema and less frequently pleural effusion, pericardial effusion, ascites and weight gain. The peripheral oedema usually starts at the lower extremities and may become generalised with a weight gain of 3 kg or more. Fluid retention is cumulative in incidence and severity. However the incidence of this is markedly reduced by the administration of corticosteroid therapy starting the day before treatment and continued for 3 days. 

Serositis (pericarditis and pericardial effusion, with or without pleural effusion) has been reported in patients taking clozapine (46-48). 

A 43-year-old man developed a pericardial effusion after taking clozapine for 7 years. The condition resolved when the drug was withdrawn. 

Pericardial effusion associated with clozapine has been reported (SEDA-27, 55) and can be accompanied by pleural effusions (49). 

A 17-year-old man took clozapine in a dose that was gradually increased to 175 mg/day, and 23 days after the start of treatment developed mild epigastric pain (188). He had raised pancreas amylase (140 U/l) and lipase (463 U/l) activities, and four days later developed increasing pain in both shoulders and a large pericardial effusion. 

Murko A, Clarke S, Black DW. Clozapine and pericarditis with pericardial effusion. Am J Psychiatry 2002 159(3) 494. 

Wehmeier PM, Heiser P, Remschmidt H. Pancreatitis followed by pericardial effusion in an adolescent treated with clozapine. J Clin Psychopharmacol 2003 23 102-3. 

Aortic arch dissection can cause profound hypotension, with global, and sometimes boundary zone, cerebral ischemia or focal cerebral ischemia if the dissection spreads up one of the neck arteries. Clues to this diagnosis are anterior chest or interscapular pain, along with diminished, unequal or absent arterial pulses in the arms or neck and a normal electrocardiogram, unlike acute myocardial infarction, acute aortic regurgitation and pericardial effusion. 

Davies D, Andrews MI, Jones JS. 1991. Asbestos induced pericardial effusion and constrictive pericarditis. Thorax 46(6) 429-432. 

Adverse effects. Molgramostim causes medullary bone pain, skin rashes, lethargy and myalgia in 10-20% of patients. It may also cause fever, the interpretation of which presents a clinical dilemma in neutropenic patients who are subject to sepsis. Pleural and pericardial effusions occur after high doses. 

Pericardial effusion In ascites, there is often (50-60%) a generally small pericardial effusion, which today can be recognized reliably with the help of echocardiography. 

Anti-Jol antibody-positive myositis, associated with pleural effusions, pericardial effusion with tamponade. 

Cardiac adverse events that have been considered probably or possibly related to pegylated liposomal doxorubicin have been reported in 3-9% of patients (14-16). These include hypotension, pericardial effusion, thrombophlebitis, heart failure, and tachycardia (14,15). 

In acute promyelocytic leukemia arsenic trioxide can cause a syndrome similar to the retinoic acid syndrome (15), with fever, skin rash, edema, pleural effusion, pericardial effusion, and acute respiratory failure. 

Cheng TO. Pericardial effusion from self-inserted needle in the heart. Eur Heart J 1991 12(8) 958. 

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