Pericardial effusion and tamponade

Question 1

Define and etiology of pericardial effusion?

Answer 1

Fluid in pericardial cavity.
Etiology:
Acute pericarditis
Idiopathic
Chest trauma
Cardiac wall rupture (MI complication)
Post pericardiotomy syndrome
Uremia
Autoimmune

Question 2

Clinical features of pericardial effusion?

Answer 2

asymptomatic
SOB, pleuritic chest pain, dysphagia, hoarseness, hiccups (phrenic nerve), MUFFLED HEART SOUNDS AND DULLNESS AT LEFT LUNG BASE

Question 3

Diagnosis and treatment of pericardial effusion

Answer 3

Echo is gold standard and enough to diagnose
ECG to rule out other causes of SOB
X-ray: cardiomegaly (flask shaped heart)
Cardiac fluid analysis is done only when etiology remains unclear (send for AFB, cell count, cytology, protein and LDH…)

Treatment is self limiting if not resolved, pericardiocentesis

Question 4

Define and pathophysiology of cardiac tamponade?

Answer 4

It’s where pericardial effusion (regardless of volume) increases intrapericardial pressure and causes compression of the heart.

Pericardial space fluid collection -> high pericardial pressure -> heart compression -> interventricular septum shifts to the left -> decrease venous return -> decrease diastolic filling -> decrease SV and CO

Question 5

Clinical features of cardiac tamponade

Answer 5

Beck triad: muffled heart sounds, hypotension, raised JVP
Tachycardia, pallor, left ventricle failure, symptoms of RHF, obstructive shock and arrest

Question 6

Diagnosis and treatment of cardiac tamponade

Answer 6

Echo is gold standard and sufficient
ECG: electric alternans (alternating QRS complexes due to swinging motion of the heart)

Cardiac tamponade is an emergency: treat with therapeutic pericardiocentesis