Pericardial Effusion

Question 1

What are the causes of a pericardial effusion?

Answer 1

Any of the causes of pericarditis or a haemopericardium

Question 2

What can cause a haemopericardium?

Answer 2

Stab wound, surgery, myocardial rupture, aortic dissection

Question 3

What are the clinical features of pericardial effusion?

Answer 3

Dyspnoea
Chest pain
Muffled heart sounds
Local structure compression: hiccoughs (phrenic nerve), nausea (diaphragm)
Ewart's sign (left lower lobe)
Signs of tamponade

Question 4

What is Ewart’s sign?

Answer 4

Bronchial breathing at the left lung base due to compression of the left lower lobe

Question 5

What tests would you perform in suspected pericardial effusion?

Answer 5

CXR, ECG, echo

Question 6

What would you find on CXR, ECG and echo in a patient with pericardial effusion?

Answer 6

CXR - Enlarged globular heart
ECG - tachycardia, low voltage QRS complexes, electrical alterans
Echo - echo free zone in heart

Question 7

What is electrical alternans?

Answer 7

When consecutive QRS complexes alternate in height due to the heart swinging in the enlarged pericardial sack.

Question 8

What is the management for pericardial effsion?

Answer 8

Treat the underlying cause
Pericardiocentesis - either diagnostic (suspected bacterial pericarditis) or therapeutic ( cardiac tamponade)
Send pericardial fluid for cultures, ZN stain and cytology