Pericardial Effusion + Cardiac Tamponade

Question 1

Definition of pericardial effusion

Answer 1

Build up of fluid in pericardial space, accompanying pericarditis

Question 2

What happens in cardiac tamponade?

Answer 2

Large vol of fluid (enough to impair ventricular filling) causes cardiac tamponade (medical emergency)

Heart cannot fully stretch out/fill properly = decreased CO - hypotension

Question 3

Causes ?

Answer 3

Typically pericarditis, RF all pericarditis relates (viral, autoimmune)

Question 4

Cardiac tamponade
Cause?

Answer 4

Fluid pooling in pericardial space
Due to: trauma (stabbing, puncture small BV), aortic dissection, MI, heart surgery

Question 5

Symptoms?

Answer 5

Related to pericarditis
Cardiac tamponade =
Beck’s triad = hypotension, high JVP, muffled S1 + S2 heart sounds
Pulsus paradoxus = fall in systolic BP of >10mmHg on inspiration (good indicator of cardiac tamponade)

Question 6

Diagnosis

Answer 6

ECG may show electrical alternans (QRS complexes have diff heights) - varying QRS amplitudes, due to heart bouncing back + forth in pericardial fluid

Chest x ray - big globular heart

ECHOcardiogram - DIAGNOSTIC - see excess fluid & heart swinging

Question 7

Treatment for effusion?

Answer 7

Underlying cause treatment should resolve problem (NSAIDS + Colchicine for pericarditis)

Question 8

Treatment for cardiac tamponade

Answer 8

Urgent pericardiocentesis (needle inserted into pericardium to drain excess fluid) & address underlying disease