Pericardial effusion Flashcards
What is a pericardial effusion
Describes a collection of fluid in the pericardial space
Types of pericardial effusions
Transudate(hydropericardium)
Exudate(pyopericardium)
Haemopericardium
Common causes of large pericardial effusions
Neoplasms Tuberculosis Uraemic pericarditis Myxoedema Parasitic infections
When are loculated effusions more common
When scarring is present(eg, post-surgery, post-trauma, post-purulent pericarditis)
Causes of pericardial effusions
Idiopathic Infectious pericarditis MI AKI/CKD Malignancy Benign tumours Hypothyroidism Trauma
Drugs associated with pericardial effusions
Hydralazine Isoniazid Minoxidil Phenytoin Anticoagulants
Symptoms of pericardial effusion
Chest pain/discomfort Light-headedness/syncope Palpitations Cough/SOB/hoarseness Anxiety and confusion
Classic triad associated with pericardial tamponade
Hypotension
Muffled heart sounds
Jugular venous distention
Signs associated with pericardial effusion
Pulsus paradoxus
Percardial friction rub
Tachycardia
Resp signs(tachypnoea, decreased breath sounds and Ewart’s sign)
Hepatosplenomegaly, weakened peripheral pulses, oedema and cyanosis
How a pericardial effusion show on an ECG
May show raised ST segments with myocardial infarction or pericarditis
Diminished QRS and T-wave voltages, PR-segment depression, ST-T changes, bundle branch block and electrical alternans
What is a raised carcinoembryonic antigen level in the presence of a pericardial fluid level highly specific for
Malignant effusion
Cardiac tamponade vs pericardial effusion
Pericardial effusion is an anatomic diagnosis of abnormal pericardial fluid accumulation that has no haemodynamic consequences, whereas cardiac tamponade is a physiologic diagnosis of varying amounts of pericardial fluid that causes haemodynamic consequences
Pharmacological management of pericardial effusions
Oxygen therapy
Treatment of underlying condition(eg cytotoxic agents for malignancy, or steroids and NSAIDs for RA)
IV fluids if hypovolaemic
Surgical interventions for pericardial effusions
Pericardiocentesis
Pericardotomy if effusion recurs
Pericardial sclerosis
When is pericardiocentesis contra-indicated
Wounds
Ruptured ventricular aneurysm
Dissecting aortic haematoma
Examples of sclerosing agents for pericardial sclerosis
Tetracycline
Doxycycline
Cisplatin
Complications of pericardial sclerosis
Severe pain
Fever
Infection
Atrial dysrhythmias
Complications of pericardial effusions
Pericardial tamponade - can lead to severe haemodynamic compromise and death
Chronic pericardial effusion(effusions lasting longer than 6 months and they are usually well tolerated)
Signs of cardiac tamponade
Distended neck veins Hypotension Tachycardia/tachypnoea Muffled heart sounds Pericardial friction rub Hepatomegaly Pulsus paradoxus
What is beck’s triad
Acute tamponade leads to increased jugular venous pressure(JVP) - jugular venous distension, hypotension and diminished heart sounds(rarely seen)
What is a good way of distinguishing patients with cardiac tamponade in patients with known pericardial effusion
Exaggeration of the normal decrease in systemic blood pressure during inspiration; a pulsus paradoxus greater than 10 mm Hg
This sign is more reliable in patients with high-pressure rather than low-pressure tamponade
Ix of choice for cardiac tamponade/pericardial effusion
Transthoracic echocardiogram
Management of cardiac tamponade
Oxygen Volume expansion(small boluses) Improve venous return(bed rest with leg elevation) Positive inotropic drugs Treat underlying cause
Example of positive inotropic drug used in cardiac tamponade management
Dobutamine
