Cardiac Tamponade in Patients With Breast Cancer: A Systematic Review

Abstract

Cardiac tamponade is a rare presentation in breast cancer and may be associated with poor prognosis. In this article, we reviewed the characteristics and survival outcomes of patients with breast cancer who developed cardiac tamponade. Three databases (PubMed, EMBASE and SCOPUS) were searched for relevant articles published from 1978 to 2022 and 16 articles were identified comprising 64 cases. The median age of the cases was 52 years. Cardiac tamponade was diagnosed with echocardiogram or computerized tomography of the chest or both in 91.9%, 1.6% and 6.5% of the cases, respectively. Cytology of the pericardial fluid was done in 90.5% of the cases while biopsy in addition to cytology was done in 9.5% of cases. Tamponade was proven to be malignant in 97.4% of the cases. The initial treatment for tamponade was pericardiocentesis. Adjunct therapies ranged from the insertion of a pericardial window, pericardiectomy, radiotherapy and chemotherapy. The median time from the first treatment of breast cancer to the onset of tamponade was 24 months while the median survival following diagnosis of tamponade was 13 months. There was no significant correlation (spearman rank-sum correlation coefficient = 0.35, p = 0.165) between time to tamponade (interval time from the first diagnosis of breast cancer and the onset of cardiac tamponade) and survival. Cardiac tamponade may adversely affect survival in patients with breast cancer. Early diagnosis with echocardiogram and cytology may guide management and expectations. Further observational studies are needed to determine the predictors of cardiac tamponade and optimal treatment in patients with breast cancer.

Pericardial Effusion as an Early Indicator of Breast Cancer Recurrence: A Case Report

“…Additionally, TTE-guided pericardiocentesis offers both diagnostic information and therapeutic relief of symptoms associated with cardiac tamponade [15]. Analysis of pericardial fluid, including cytological examination and biochemical analysis, helps confirm the etiology of pericardial effusion, as observed in our case [3].…”

“…Addressing pericardial effusion resulting from breast cancer recurrence demands a collaborative effort among oncologists, cardiologists, and palliative care specialists [3]. Treatment objectives focus on alleviating symptoms, enhancing quality of life, and extending survival.…”

“…Among these neoplasms, breast cancer is the most prevalent malignancy in women worldwide, and despite advancements in treatment, recurrence remains a significant concern [2]. Recurrence can manifest at multiple sites, including the pericardium, presenting diagnostic and therapeutic challenges [3]. Pericardial effusion secondary to breast cancer recurrence is rare, but it carries substantial morbidity and mortality, especially when it is complicated by a tamponade.…”

Idiopathic Pericarditis Leading to Hemorrhagic Pericardial Effusion- A Case Report and Review

“…In patients with breast cancer who develop pericardial effusion, a significant number of cases are due to malignancy. 5 However, the pericardial fluid analysis did not show malignant cells for our patient. Our patient also had no evidence of cardiac injury or recent procedures that would lead us to believe this was secondary to post-myocardial infarction inflammation, which is also associated with hemorrhagic effusions.…”

Case report: Successful treatment of malignant pericardial effusion with pericardiocentesis, concurrent anti-inflammatory therapy and cancer therapy

“…The oncologic prognosis of malignant PE and concomitant cardiac tamponade associated with breast cancer has been known to be poor, with a median survival of 13 months ( 7 ). This might be caused not only by the heavy cancer burden represented by pericardial invasion, but also by difficulty in continuing cancer therapy due to heart failure symptoms associated with CP after pericardiocentesis.…”