Pericardial effusion

Question 1

what is the definition of pericardial effusion?

Answer 1

Pericardial effusion is present when the fluid in the pericardial space exceeds its physiological amount (≤50 mL).

Question 2

what is the epidemiology of pericardial effusion?

Answer 2

Higher prevalence on emergency wards

Relatively common

Question 3

what is the aetiology of pericardial effusion?

Answer 3

The most common causes of pericardial effusion include malignancy (25% to 32%), infection (7% to 24%), and iatrogenic (15% to 21%). In addition, a substantial proportion of pericardial effusions is considered idiopathic (16% to 26%)

Question 4

what is the pathophysiology of pericardial effusion?

Answer 4

reserve volume is exceeded, pericardial pressure increases rapidly and significantly limits cardiac filling.
pericardial pressure-volume relationship reaches its non-compliant stage, expansion is limited and small increases in volume produce a dramatic increase in pericardial pressure, severely impairing ventricular filling.

Question 5

what are the signs of pericardial effusion?

Answer 5

Patients who have any systemic disorder known to involve the pericardium and a raised jugular venous pressure
Unexplained cardiomegaly without pulmonary congestion on chest x-ray.
Cardiac arrest with pulseless electrical activity or asystole.
Pericardial friction rub
Distant heart sounds
pulsus paradoxus

Question 6

what are the symptoms of pericardial effusion?

Answer 6

Otherwise unexplained chest discomfort, pleuritic pain, and dyspnoea.
Chest pain and/or haemodynamic instability after recent blunt trauma to the chest, cardiac surgery, or cardiac intervention.

Question 7

what are the first line and gold standard investigations for pericardial effusion?

Answer 7

ECG - sinus tachycardia, low QRS voltage, electrical alternans
Echocardiogram - An echo-free space between the two layers of the pericardium indicates the presence of an effusion.
CXR - water bottle shaped cardiac silhouette with distinct pericardial fat stripe
FBC - high WBC
Serum C-reactive protein - elevated
Erythrocyte sedimentation rate - elevated

Question 8

what are the differential diagnoses for pericardial effusion?

Answer 8

Malignancy
Viral pericarditis
Congestive heart failure

Question 9

what is the prognosis of pericardial effusion?

Answer 9

The significance of effusions lies in their relationship to an underlying disease state and in their potential to affect a patient’s haemodynamics