Pericardial effusion + cardiac tamponade Flashcards
What is a pericardial effusion?
Accumulation of fluid in the pericardial sac
Normally 10-50mL
Name the causes of pericardial effusion
Pericarditis
Myocardial rupture (i.e., haemopericardium - surgical, stab wound, post-MI)
Aortic dissection
Pericardium filling with pus
Malignancy
What are the clinical features of a pericardial effusion?
Dyspnoea
Chest pain
Signs of local structures being compressed e.g.,
- hiccoughs = phrenic N
- nausea = diaphragm
- bronchial breathing at left base = Ewart’s sign (compressed left lower lobe)
Muffled heart signs
Look for signs of cardiac tamponade
What is a cardiac tamponade?
A pericardial effusion that raises intrapericardial pressure
Reduces ventricular filling
Hence cardiac output drops
What can a cardiac tamponade rapidly cause?
Cardiac arrest
What are the signs of a cardiac tamponade?
Increased pulse
Reduced BP
Pulsus paradoxus - an abnormally large decrease of > 10mmHg in systolic BP
Increased JVP
Kussmaul sign (paradoxical rise in right atrial pressure during inspiration)
Muffled S1 and S2
What is Beck’s triad and what is used for?
Falling BP
Rising JVP
Muffled heart sound
Used to diagnose cardiac tamponade
What diagnostic test can you do for a pericardial effusion and cardiac tamponade?
ECG
* low QRS voltage +/- electrical alternans
Echo (diagnostic)
* echo free zone around the heart (>2cm or >1cm if acute) +/- (in cardiac tamponade) diastolic collapse of right atrium and right ventricle
How would you manage a pericardial effusion/cardiac tamponade?
Seek senior expert help
Pericardial effusion needs urgent drainage
Send fluid for culture, Ziehl-Neelsen stain/TB culture, and cytology
Source
Pg 154 Oxford Handbook of Clinical Medicine 10th Edition
https://erj.ersjournals.com/content/42/6/1696
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.120.007461#:~:text=Kussmaul’s%20sign%20is%20the%20paradoxical,right%20ventricular%20(RV)%20compliance.
