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Pericardial effusion


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pericardial effusion

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Pericardial effusion

  1. 1. Pericardial Effusion and Cardiac Tamponade Patrick Selakovich, M.D. PGY-1
  2. 2. Pericardial Effusion Etiologies – Acute pericarditis (viral, bacterial, tuberculous, or idiopathic in origin) Autoimmune disease Postmyocardial infarction or cardiac surgery; sharp or blunt chest trauma, including a cardiac diagnostic or interventional procedure Malignancy, mostly metastatic; chemo, radiation to the chest Uremia; Myxedema Aortic dissection extending to the pericardium Certain drugs
  3. 3. Clinical Presentation Significant symptoms only present with effusion leading to tamponade fatigue, dyspnea, chest discomfort, elevated jugular venous pressure, edema ECG findings — most commonly – sinus tachycardia, low QRS voltage, and electrical alternans Enlarged cardiac silhouette seen on CXR with significant effusions
  4. 4. Electrical Alternans
  5. 5. Diagnosis Establishing the presence of pericardial effusion Echocardiogram (either TTE or TEE) Can see fluid collections and atrial collapse as well as depressed wall motion CT or MRI Establish the size by either echo or MRI/CT (better) Assess hemodynamic impact Acute cardiac tamponade Chronic tamponade
  6. 6. Cardiac Tamponade Acute Symptoms include chest pain and dyspnea Signs include tachycardia, hypotension, elevated JVP, pulsus paradoxus and muffled heart sounds Chronic/Subacute Mild shortness of breath, fatigue, and possible peripheral edema Narrow pulse pressure and mild hypotension
  7. 7. Treatment If patient is unstable, emergent pericardiocentesis is indicated Pericardiocentesis is usually done under ultrasound/echocardiogram guidance or using direct fluoroscopy A pigtail drainage catheter is typically placed It can also be done surgically: subxiphoid, VATS for pericardial window, pericardio-peritoneal drainage and pericardiectomy These surgical approaches are typically reserved for more stable/chronic effusions
  8. 8. References Hoit, Brian D. “Diagnosis and treatment of pericardial effusion.” Up to Date. 20 November 2013. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. (2008). Harrison's Principles of Internal Medicine (17th ed.). New York: McGraw-Hill Medical Publishing Division