Pricardial effusion associated with Infective Endocarditis : Incidence , mechansim and clinical Implication.
Pericardial effusion is often detected in patients with Infective endocarditis. Incidence can be as high as 25% . Most often it is mild, can be moderate in few.
Mechanism
Sympathetic effusion in response to endocardial infection. It’s never more than minimal. (Evidence ? it’s only an assumption)
IE related cardiac failure (Raised systemic venous pressure to which pericardial veins drain)
Local sepsis, Abcess formation tracks to pericardial space through transmural lymphatics
Fungal , granulomatous , Tuberculous IE (Rare) Here IE and PE share the same pathology
Part of systemic sepsis activated Immune mechanism (Polyseroists)
Renal Involvement of IE-Renal failure
Postoperative pericardial effusion in Prosthetic valve IE (Common, often loculated)
Clinical Implication
If the pericardial effusion is more than mild, it often denotes worse outcome. This implies more extensive infection or a marker of extracardiac causes of effusion like renal dysfunction.
Effusion may predispose to local dissemination of infection and ends up as peri-annular abscess is whether it is a cause or effect of effusion remains to be understood.It is often exudate as one would expect, but transudative effusions also occur and would indicate more benign course.
The sterility of pericardial fluid has not been proven. Culture studies are rarely done from effusions associated with IE.
Pericardial effusions appear more often seen in IE of right heart valves. They turn out to be IV drug ab...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics Cardiology -unresolved questions Infrequently asked questions in cardiology (iFAQs) pericardial disease pericardial effusion Pericardium infective endocarditis pericardial effusion in infective endocarditis Source Type: blogs
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