Pericardial Disease - Pericardial Effusion and Cardiac Tamponade Flashcards
What is Pericardial Effusion?
A state where excess fluid collects within the pericardial sac to fill the entire pericardial cavity or only a localised section.
What can the effusion be made up of? (5)
- Transudates.
- Exudates.
- Blood.
- Pus.
- Gas (Bacterial Infections).
What is the Pericardium?
A membrane that surrounds the heart - 2 layers with a small amount of fluid to provide lubrication and separate the heart from the rest of the contents of the mediastinum.
How is the Pleurae similar to the Pericardium?
Both are POTENTIAL SPACEs between the 2 layers.
What is the difference between Pericardial Effusion and Pericardial/Cardiac Tamponade?
Pericardial Effusion : the potential space fills with fluid creating an inward pressure on the heart, making it more difficult to expand during diastole.
Cardiac Tamponade : large enough to raise the intra-pericardial pressure - an emergency since there is reduced CO.
What may cause a transudative pericardial effusion?
Increased venous pressure results in reduced drainage - CCF, Pulmonary HTN.
What may cause an exudative pericardial effusion? (6)
Inflammatory process - pericarditis e.g.
1. Infection (TB, HIV, Cox-Sackie, EBV).
2. Autoimmune : SLE, RA.
3. Injury : MI, Surgery, Trauma.
4. Uraemia : Renal Impairment.
5. Cancer.
6. Medications : Methotrexate.
Aetiology of a Rapid-Onset Cardiac Tamponade (3).
Rupture of Heart/Aorta = Bleeding into the Pericardial Cavity :
1. MI.
2. Trauma.
3. Type A Aortic Dissection.
Clinical Presentation of Chronic Pericardial Effusion (5).
- Initially Asymptomatic.
- Chest Pain.
- SOB.
- Feeling of Fullness in Chest.
- Orthopnoea.
How would a Cardiac Tamponade present?
Haemodynamic Compromise and Collapse.
Give 3 extra-cardiac symptoms of a Pericardial Effusion.
- Hiccups - Phrenic Nerve Compression.
- Dysphagia - Oesophageal Compression.
- Dysphonia - Recurrent Laryngeal Nerve Compression.
Give 4 signs on examination of Pericardial Effusion.
- Quiet Heart Sounds.
- Pulsus Paradoxus.
- Hypotension.
- Raised JVP.
What is Beck’s Triad?
CARDIAC TAMPONADE TRIAD :
1. Hypotension.
2. Raised JVP.
3. Muffled Heart Sounds.
What is Pulsus Paradoxus?
An abnormally large drop in BP during inspiration, notably when palpating the pulse.
What is the investigation of choice in Pericardial Effusion & what is its role?
Echocardiogram :
1. Diagnosis.
2. Assess Size.
3. Assess Haemodynamic Effect.
What other investigation can be used, to diagnose the underlying cause? (3)
FLUID ANALYSIS :
1. Protein Content.
2. Bacterial Culture, Viral PCR.
3. Cytology, Tumour Markers.
What is the ECG finding in Cardiac Tamponade?
Electrical Alternans (alternation of QRS complex amplitude between beats).
How can Cardiac Tamponade be differentiated from Constrictive Pericarditis? (4)
CONSTRICTIVE PERICARDITIS :
1. JVP - X+Y Present (Absent Y Descent in Cardiac Tamponade).
2. No Pulsus Paradoxus.
3. Kussmaul’s Sign (Rare in Cardiac Tamponade).
4. CXR : Pericardial Calcification (n/a in Cardiac Tamponade).
Aims of Management of Pericardial Effusion (2).
- Treatment of Underlying Cause.
- Drainage of Effusion.
How can Inflammatory Causes of Pericardial Effusion be treated? (4)
- Aspirin.
- NSAIDs.
- Colchicine.
- Steroids.
What are the 2 options for draining an effusion?
- Needle Pericardiocentesis (ECHO-guided).
- Surgical Drainage.
What is a Pericardial Window?
Surgical procedure - removal of a portion of the pericardium to create a window/fistula to allow fluid to drain from the pericardial cavity into the pleural cavity or the peritoneal cavity.
What management option may be used in recurrent cases?
Rarely, PERICARDIECTOMY.
Management of Cardiac Tamponade.
Urgent Pericardiocentesis.
What is a complication of Pericardiocentesis?
Pneumothorax : CXR Post-Procedure.
