Pericardial Effusion + Cardiac Tamponade Flashcards
Pericardial effusion Definition
Acumillation of fluid in pericardial space, accompanying pericarditis, large volume fluid (>50ml) (enough to impair ventricle filling) -> embarrassment of the circulation = Cardiac tamponade
Cardiac tamponade definition
Where the cardiac chambers can’t fill with blood properly = decreased cardiac output = cardiac emergency = can be fatal if not quickly diagnosed + treated properly
What can the effusions be made of?
Transudates (low protein content)
Exudate (associated with inflammation)
Blood
Pus
Gas (associated with bacterial infection)
Aetiology
Large idiopathic pericardial effusion
Typically pericarditis
Myocardial rupture
Aortic dissection
Pericardium filling with pus
Malignancy
Signs + Symptoms of pericardial effusions
Dyspnoea
Raised JVP
Chest pain
Muffled heart sounds + obscured apex beat
Signs of local structures being compressed
- hiccoughs (phrenic nerve)
- hoarse voice (RLN)
- nausea (diaphragm)
- bronchial breathing at left base (Ewarts sign = compressed lower left lobe)
Signs of cardiac tamponade
BECKS TRIAD =
- hypotension (falling bp)
- increased JVP
- muffled S1 + S2 heart sounds
PULSUS PARADOXES = fall in systolic BP of 10+ mmHg on inspiration (good indication of C.T) - this is assosciated with:
KUSSMAULS (cardiac) SIGN = paradoxical increase in JVP with inspiration
Diagnosis
CXR - enlarged globular heart if effusion >300ml
ECG - varying QRS amplitudes, due to heart bouncing back and forth in increased pericardial fluid
GOLD STANDARD = ECHO - Echo free zone surrounding the heart
Cardiac tamponade specific signs =
- BECKS TRIAD (Hypotension, increased JVP, muffled s1 + s2 heart sounds)
- kussmauls (cardiac) sign
Treatment
Pericardial effusion - treat underlying cause
E.g Pericarditis - NSAIDS + 3 months colchicine
Cardiac tamponade - URGENT PERICARDIOCENTESIS
