Pericardial effusion

Question 1

What is pericardial effusion?

Answer 1

Accumulation of fluid in pericardial sac

Question 2

What are the causes of pericardial effusion?

Answer 2

Blood or serous fluid
Pericarditis, myocardial rupturem aortic dissection
Malignancy, pericarditis

Question 3

What are the clinical features of pericardial effusion?

Answer 3

Initially asymptomatic
Retrosternal chest pain
Compressive symptoms (i.e. Hoarseness, Nausea, Dysphagia, Hiccups)
Non-palpable apex beat
Ewart’s (dullness at the base of the left lung, with increased vocal fremitus and bronchial breathing)

Question 4

How is pericardial effusion diagnosed?

Answer 4

(CXR) Enlarged globular heart
(ECG) Low voltage QRS complex + electrical alternans (alternating QRS morphologies)
(Echocardiography) Echo-free zone surrounding heart

Question 5

What are the appropriate laboratory studies?

Answer 5

CBC → leukocytosis if infection or inflammation
CRP, ESR → elevated in infection or inflammation
Troponin → slightly elevated in pericarditis; significantly elevated in myocarditis
Creatinine kinase → elevated in myocarditis, rhabdomyolysis
Blood urea nitrogen in uremic pericarditis

Question 6

What is the treatment for pericardial effusion?

Answer 6

Treat underlying cause

Pericardiocentesis may be diagnostic (i.e. bacterial pericarditis) + therapeutic (i.e. cardiac tamponade)