Malignant pericardial effusion in palliative care
Malignant pericardial effusion in patients with palliative care needs can occur due to local metastases or cancer-induced lymphatic obstruction. Pericardial effusions are often asymptomatic and found incidentally, and does not require intervention, although monitoring may be required.
Pericardial effusions that grow until pericardial fluid pressure is greater than the intracardiac filling pressure can lead to cardiac tamponade, which is a medical emergency. If cardiac tamponade occurs, carefully consider the potential benefits and burdens of treatment, and the patient’s prognosis, preferences and goals of care—see Emergencies in palliative care. Seek specialist advice (eg cardiology, oncology) if the patient’s condition warrants discussion of active treatment options. Surgical options include pericardiocentesis and surgical pericardial window. Pericardiocentesis is less invasive compared to surgical pericardial window and can be performed promptly; however, the effusion is more likely to recur compared to surgical pericardial window. Radiation or chemotherapy can also reduce recurrence in sensitive malignancies.
For symptomatic management of breathlessness, see Breathlessness in palliative care and Severe acute breathlessness in palliative care.
For management of symptoms in the last days of life, see Principles of care in the last days of life.
If death appears imminent, see Catastrophic terminal events in palliative care for management.