Pericardial Effusion & Cardiac Tamponade Flashcards
What is pericardial effusion?
Accumulation of fluid in the serous pericardial sac.
Causes of pericardial effusion
Pericarditis
Myocardial rupture
Aortic dissection
Pericardium filling with pus
Malignancy
Clinical features of pericardial effusion.
SOB
Chest pain
Signs of local structures being compressed - hiccups (phrenic nerve), nausea (diaphragm), bronchial breathing at left base (Ewart’s sign . compressed left lower lobe)
Muffled heart sounds
Investigations of pericardial effusion.
ECG
CXR
Echocardiography
Pericardiocentesis (if suspecting TB, malignancy or purulent effusion)
Pericardial biopsy (if TB suspicion)
CXR findings in pericardial effusion.
Enlarged globular heart if the effusion is > 300 ml.
Water bottle sign
ECG findings in pericardial effusion.
Low-voltage QRS complexes with sinus tachycardia.
Electric alternans (amplitude of QRS changes)
Management of pericardial effusion.
Treat the underlying cause.
Most will resolve spontaenously.
Pericardiocentesis may be diagnostic or therapeutic such as in cardiac tamponade.
Send pericardial fluid for culture, ZN stain/TB culture and cytology.
What is cardiac tamponade?
A pericardial effusion that raises intrapericardial pressure, large enough to cause ventricular filling to be reduced and compromised.
This will decrease cardiac output and can lead rapidly to cardiac arrest.
Causes of cardiac tamponade.
Similar to pericardial effusion.
Malignancy
Pericarditis
Trauma
MI
Kidney failure
Signs of cardiac tamponade.
Tachycardia
Low BP
Pulsus paradoxus
Raised JVP
Kussmaul’s sign (maybe not???)
Muffled S1 and S2
Investigations of cardiac tamponade.
Beck’s triad
ECG
Echo - diagnostic
What is Beck’s triad?
Falling BP
Rising JVP
Muffled heart sounds
ECG findings in Cardiac tamponade.
Low voltage QRS +/s electrcal alternans.
Very similar to pericardial effusion.
Management of cardiac tamponade.
Seek expert help.
Pericardial effusion needs to be drained urgently via pericardiocentesis.
Send fluids for culture, ZN stain/TB culture and cytology.
Echo findings in cardiac tamponade.
