Cause of Pericardial Effusion in Pulmonary Hypertension: Pathogenesis
It is not clearly understood why patients with pulmonary hypertension (PH) develop pericardial effusions. However, the presence of a pericardial effusion portends a poor prognosis and is linked to a risk of early mortality.
One of the leading theories as to why patients develop a pericardial effusion is an inability to reabsorb subepicardial venous and lymphatic drainage into the right atrium. Because the chronically overloaded right atrium is unable to accommodate this drainage, it results in the formation of a pericardial effusion.
The goal with PH directed therapy is to improve pulmonary vascular resistance in hopes that the pericardial effusion will improve. Consideration of pericardiocentesis if clinical tamponade is suspected.
Sahay, S., & Tonelli, A. R. (2013). Pericardial effusion in pulmonary arterial hypertension. Pulmonary circulation, 3(3), 467–477.
Fenstad, Eric R.; Le, Rachel J.; Sinak, Lawrence J.; Maradit-Kremers, Hilal; Ammash, Naser M.; Ayalew, Assefa M.; Villarraga, Hector R.; Oh, Jae K.; Frantz, Robert P.; McCully, Robert B.; McGoon, Michael D.; Kane, Garvan C. (2013). Pericardial Effusions in Pulmonary Arterial Hypertension. Chest, 144(5), 1530–1538.
Adams JR, Tonelli AR, Rokadia HK, Duggal A. Cardiac tamponade in severe pulmonary hypertension. A therapeutic challenge revisited. Ann Am Thorac Soc. 2015;12(3):455-460.