Pericardial Effusion Flashcards
Define Pericardial Effusion
an abnormal accumulation of fluid around the heart in the pericardial cavity
What are common causes of pericardial effusion?
- Idiopathic
- Breast cancer
- Lung cancer
- Leukemia/lymphoma
How does extra pericardial fluid affect the heart?
fluid accumulation places extra pressure on the heart reducing left ventricular filling volumes leading to a drop in cardiac output
What are some common manifestations of pericardial effusion?
- chest pain, pressure, discomfort
- palpitations
- cough, hoarseness
- anxiety, confusion
How is pericardial effusion diagnosed?
Echocardiogram
How is pericardial effusion treated?
- NSAIDs
- Colchicine
- Corticosteroids
- Antibiotics
- Drain effusion
A patient presents with dyspnea and cough. Exam reveals low- grade fever, tachycardia, tachypnea, and a pericardial friction rub. There is no edema or jugular venous distention. What other finding is most likely present on exam?
A. hepatomegaly
B. orthostatic hypotension
C. pulsus paradoxus
D. scattered wheezes
The answer is C.
A. Hepatomegaly and scattered wheezes in a patient with
dyspnea and cough indicate congestive heart failure.
B. Orthostatic hypotension indicates a volume deficit.
C. Pulsus paradoxus is a classic finding in pericardial effusion.
D. See A.
A 45-year-old male who is recuperating from influenza suddenly develops sharp substernal pain in his chest. He cannot get comfortable lying down, but is able to get some relief by sitting forward. He also feels as if he cannot get a deep breath, but has no other symptoms other than residual cough from the flu. On cardiac auscultation, a squeaking sound is heard. His ECG demonstrates ST and T wave changes in all leads. CXR is unremarkable. What is the most likely diagnosis?
A. acute coronary event
B. anginapectoris
C. costochrondritis
D. inflammatory pericarditis
The answer is D.
A. The pain of an acute coronary event or of angina is more likely to be crushing or squeezing than sharp and is not
relieved by sitting forward.
B. See A.
C. Costochondritis may present with sharp pain associated with movement but has no associated ECG changes.
D. This presentation is classic for acute pericarditis following
a viral infection, which is the most common cause of inflammatory pericarditis
A 53-year-old male presents to the emergency department with a 3-hour history of sharp, pleuritic central chest pain that began at rest. This pain is described as worsening in the supine position and improving whenever he sits up and leans forward. Exam does not reveal a murmur but does reveal a two-phase friction rub heard best at the left lower sternal border. Which of the following would best aid in determining the diagnosis?
A. cardiac catheterization
B. cardiac enzymes
C. electrocardiography
D. pericardial window
The answer is C.
A. Cardiac catheterization is an invasive procedure. It is not
indicated in suspected pericarditis.
B. Cardiac enzymes would be indicated to rule out a suspected myocardial infarction.
C. Electrocardiography frequently reveals diffuse ST and T wave changes in pericarditis. This along with the presentation can make the diagnosis.
D. Pericardial window may be necessary as a therapy for refractory cases.
An electrocardiogram (ECG) shows a sinus rhythm with varying T wave heights, axis changes every other beat and a wandering baseline. Which of the following is most likely the diagnosis?
A. Artifact
B. Digoxin toxicity
C. Pericardial effusion
D. Poor lead placement
The answer is C.
A. Artifact could show a wandering baseline, but not the distinct axis changes.
B. Digoxin toxicity can cause bidirectional tachycardia, but not electrical alternans.
C. This ECG pattern best represents pericardial effusion due to a swinging heart in fluid and is known as electrical alternans.
D. Poor lead placement would show different patterns per the leads.
A 25 year-old female presents with a three-day history of chest pain aggravated by coughing and relieved by sitting. She is febrile and a CBC with differential reveals leukocytosis. Which of the following physical exam signs is characteristic of her problem?
A. Pulsus paradoxus
B. Localized crackles
C. Pericardial friction rub
D. Wheezing
The answer is C.
A. Pulsus paradoxus is a classic finding for cardiac tamponade.
B. Localized crackles are associated with pneumonia and consolidation, not pericarditis.
C. Pericardial friction rub is characteristic of an inflammatory pericarditis.D. Wheezing is characteristic for pulmonary disorders, such as asthma.
A 22 year-old male received a stab wound in the chest an hour ago. The diagnosis of pericardial tamponade is strongly supported by the presence of
A. pulmonary edema.
B. wide pulse pressure.
C. distended neck veins.
D. an early diastolic murmur.
The answer is C.
A. Pulmonary edema may result with low output states as seen with myocardial contusions, but it is not strongly suggestive of tamponade.
B. Wide pulse pressure is seen in conditions of high stroke volume such as aortic insufficiency or hyperthyroidism. Narrow pulse pressure is seen with cardiac tamponade.
C. Cardiac compression will manifest with distended neck veins and cold clammy skin.
D. The onset of diastolic murmur is suggestive of valvular disease, not tamponade.
