Derrame Pericárdico Flashcards
Causas gerais
Any pathological process usually causes an inflammation with
the possibility of increased production of pericardial fluid (exudate).
An alternative mechanism of accumulation of pericardial fluid may
be decreased reabsorption due to a general increase in systemic
venous pressure as a result of congestive heart failure or pulmonary
hypertension (transudate)
Classificação
Pericardial effusion may be classified
according to its onset (acute or subacute vs. chronic when lasting
.3 months), distribution (circumferential or loculated), haemo-
dynamic impact (none, cardiac tamponade, effusive-constrictive),
composition (exudate, transudate, blood, rarely air, or gas from bac-
terial infections) and, in particular, by its size based on a
simple semiquantitative echocardiographic assessment as mild
(,10 mm), moderate (10–20 mm) or large (.20 mm)
Etiologias mais comuns em paises desenvolvidos e no BR
idiopathic in developed countries (up to 50%), while other common
causes include cancer (10–25%), infections (15–30%), iatrogenic
causes (15–20%) and connective tissue diseases (5–15%), whereas
TB is the dominant cause in developing countries (.60%), where
TB is endemic
Correlação clínica com velocidade de acumulação de fluido pericardico
If pericardial fluid is rapidly accumulating, such as after wounds or iatrogenic perforations, the evolution is dramatic and even small amounts of blood may cause an increase in intrapericardial pressure within minutes and overt cardiac tamponade. On the other hand, a slow accumulation of pericardial fluid allows the collection of a large effusion in days to weeks before a significant increase in pericardial pressure causes symptoms and signs
Sintomas clássicos (quando há)
Classic symptoms include dyspnoea on exertion progressing to
orthopnoea, chest pain and/or fullness. Additional occasional symptoms due to local compression may include nausea (diaphragm), dysphagia (oesophagus), hoarseness (recurrent laryngeal nerve) and hiccups (phrenic nerve).
Exame físico
Physical examination may be absolutely normal in patients without haemodynamic compromise. When tamponade develops, classic signs include neck vein distension with elevated jugular venous pressure at bedside examination, pulsus paradoxus and diminished heart sounds on cardiac auscultation in cases of moderate to large effusions.82 – 84 Pericardial friction rubs are rarely heard; they can usually be detected in patients with concomitant pericarditis
Principal exame para diagnostico e avaliação das dimensões do derrame
Ecocardiografia
Que exames complementares devem ser pedidos para pacientes com suspeita de derrame pericárdico?
Eco transtorácico RX de tórax Avaliação de marcadores inflamatórios (PCR) TC ou RM cardíaco should be considered in suspected cases of loculated pericardial effusion, pericardial thickening and masses, as well as associated chest abnormalities
Tamponamento cardíaco por derrame pericárdico SEM marcadores inflam aumenta o risco para qual etiologica?
Neoplásica
Quando deve ser considerado drenagem pericárdica?
When a pericardial effusion becomes symptomatic without evidence of inflammation or when empiric anti-inflammatory drugs are not successful
TT do derrame deve ser orientado de acordo com etiologia. V/F?
V
Quando deve ser considerado pericardiectomia?
should be considered whenever fluid reaccumulates, becomes loculated or biopsy material is required
Derrame pericárdico associado a elevação de marcadores inflamatórios. tt?
Tratar como pericardite. Drenagem não é necessária.
Indicações para drenagem ou cirurgia cardíaca
Pericardiocentesis or cardiac surgery is indicated for cardiac tamponade or for symptomatic moderate to large pericardial effusions not responsive to medical therapy, and for suspicion of unknown bacterial or neoplastic aetiology
Prognóstico de derrame pericárdico Idiopático e de etiologia pericardite
Idiopathic pericardial effusion and pericarditis have an overall good prognosis with a very low risk of complications, especially if the effusion is mild to moderate
Prognóstico de derrame pericárdico idiopático de acordo com o volume, correlacionando com tempo para reavaliação com Eco
A mild idiopathic effusion (,10 mm) is usually asymptomatic,
generally has a good prognosis and does not require specific monitoring
Moderate to large effusions (.10 mm) may worsen, and
especially severe effusions may evolve towards cardiac tamponade in up to one-third of cases.
For idiopathic moderate effusions, an
appropriate timing for echocardiographic follow-up may be an
echocardiogram every 6 months. For a severe effusion, an echocardiographic follow-up may be every 3–6 months
