Pericardial effusion

Question 1

Normal amount of thin serous fluid in pericardium

Answer 1

15-50mL

Question 2

How much fluid can pericardium accommodate with only slight increase in pressure?

Answer 2

200mL

Question 3

sudden increase in fluid to ______ can cause sharp rise in pericardial pressure

Answer 3

200-300mL

Question 4

slow rise up to ____ can be accommodated w/ minimal pressure increase

Answer 4

2 liters

Question 5

Common causes

Answer 5

viral myopericarditis
metastatic malignancy
autoimmune disease
renal failure

Question 6

viral infection of pericardium

Answer 6

generally involves myocardium too, so called “myopericarditis”

Question 7

hemopericardium

Answer 7

bleeding into the pericardium
(b/c blood is unique fluid, often considered apart from pericardial effusion causes)

rare, but fatal

Question 8

Symptoms

Answer 8

dull, constant left chest ache
dyspnea

hiccups (phrenic nerve irritation)
dysphagia (esophagus compression)

Question 9

Diagnosis

Answer 9

chest x-ray

• -enlarged globular cardiac silhouette if over 200mL
• -impossible to distinguish b/w effusion and cardiomegaly

Echocardiogram

• -Can differentiate b/w effusion and cardiomegaly
• -size ESTIMATE of effusion
• -evidence of cardiac tamponade

Electrocardiogram
–decreased voltage of QRS

Pericardiocentesis

• -tapped and examined…good sometimes for Dx of metastatic malignancy
• -best for cardiac tamponade (diagnostic AND therapeutic)

Question 10

Causes of hemopericardium

Answer 10

cardiac rupture

aortic rupture secondary to aortic dissection

chest trauma

anticoagulation

leukemia