Pericardial Effusion Flashcards
What is the typical volume of fluid in the pericardial sac?
Less than 50 mL
What are the layers of the myocardial structure from outer to inner?
- Fibrous layer (outer)
- Serous layer (inner)
- Pericardial sac (cavity)
- Serous layer (visceral)
- Epicardium
- Mid wall
- Endocardium
What are the roles of the pericardium?
- Stabilizes the heart in the thorax
- Protects the heart from infection
- Acts as a lubricant during heart function
What is pericarditis?
Inflammation of the pericardium
What is the primary cause of pericarditis?
Idiopathic or viral
What results from pericarditis?
Abnormal accumulation of fluid
What are the variances of pericardial disease?
- Fibrin deposition
- Hemorrhagic exudate
- Collagen deposition
What is Dressler syndrome?
Secondary form of pericarditis occurring after injury to the heart or pericardium
What are the symptoms of Dressler syndrome?
- Fever
- Chest pain
- Pericarditis/pericardial fusion
What is cardiac tamponade?
Increased pericardial pressure due to accumulation of fluid
What should be the pressure within the pericardial space?
0 mmHg
What occurs when pericardial pressure exceeds cardiac pressure?
Impaired diastolic filling and reduction in stroke volume
What are the clinical signs/symptoms of pericardial effusion?
- Dyspnea that improves when leaning forward
- Chest pain
- Near syncope
- Tachycardia
What is Beck’s triad?
- Hypotension due to lack of filling
- Muffled heart sounds
- Increased venous pressure due to increased resistance
What is pulses paradoxus?
A hallmark finding in cardiac tamponade where blood pressure decreases during inhalation
What confirms the presence of pulses paradoxus?
Dropping in systolic blood pressure greater than 10 mmHg upon inspiration
What are the characteristics of hypotension due to lack of filling?
- Narrow pulse pressure (e.g., 100/80)
- Tachycardia
What size is classified as trivial pericardial effusion?
Less than 5 mm
This classification helps in assessing the clinical significance of the effusion.
What size range is considered small pericardial effusion?
Greater than 5 mm but less than 10 mm
Understanding the size of the effusion is critical for management decisions.
What size range is classified as moderate pericardial effusion?
Greater than 10 mm but less than 20 mm
This classification is important for evaluating the risk of tamponade.
What size is considered large pericardial effusion?
Greater than 20 mm
Large effusions are more likely to cause clinical symptoms and complications.
When should pericardial effusion be measured?
At end diastole
Measuring at this time provides the most accurate assessment of the effusion’s impact.
What are the characteristics of low pressure/small effusion tamponade?
Normal blood pressure, borderline, tacky, right ventricular diastolic collapse
This condition may still present with significant clinical signs despite normal pressures.
What echo findings indicate tamponade?
Echo free space especially during diastole, right ventricular diastolic collapse
These findings are crucial for the diagnosis of cardiac tamponade.
What does respiratory variation in Doppler findings indicate?
May indicate tamponade
Changes in E wave during respiration are significant in assessing hemodynamic status.
What are the characteristics of a small chronic pericardial effusion?
Normal heart rate, no right ventricular collapse, normal blood pressure
This presentation may require monitoring rather than immediate intervention.
What is the clinical presentation of moderate pericardial effusion with tamponade?
Hypotensive, tachycardic, right ventricular diastolic collapse
This combination of signs indicates a need for urgent intervention.
What are the key features of pericardial effusion with tamponade?
Hypotensive, right ventricular diastolic collapse, circumferential pericardial effusion, causing a swinging heart
These clinical signs are critical for diagnosing and managing tamponade.
What E wave changes indicate potential tamponade on the mitral valve?
E wave increases greater than 40% during expiration
This measurement helps assess diastolic function and potential hemodynamic compromise.
What E wave changes indicate potential tamponade on the tricuspid valve?
E wave increases greater than 25% upon inspiration
This finding is important for evaluating right heart function.
What should be measured to assess the E wave changes?
E wave of changes on mitral valve, use MO on subcostal to evaluate right ventricular diastolic collapse
These measurements provide insights into the fluid dynamics and cardiac function.
What should be assessed during the sonographers approach to pericardial effusion?
Assess pericardial space in all views, measure fluid in all spaces, assess all chambers for collapse, use pulse wave on tricuspid and mitral valve
A comprehensive assessment is essential for accurate diagnosis and management.
What does IVC collapse ability indicate?
Right atrial pressure
Assessing IVC collapse is crucial for estimating volume status and cardiac filling pressures.
What does hepatic vein diastolic flow reversal indicate?
Diastolic flow reversal during expiration
This finding may suggest elevated right atrial pressures or tamponade physiology.
