Pericardial effusion: Difference between revisions

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'''Pericardial effusion''' refers to accumulation of pathological amounts of fluid in the pericardial cavity. In physiological cases there is 15-50 mL of fluid in the cavity. It may cause [[cardiac tamponade]], which is an emergency. If the fluid is blood it's called haemopericardium.
<section begin="radiology" />'''Pericardial effusion''' refers to accumulation of pathological amounts of fluid in the pericardial cavity. In physiological cases there is 15-50 mL of fluid in the cavity. It may cause [[cardiac tamponade]], which is an emergency. If the fluid is blood it's called haemopericardium.


'''Cardiac tamponade''' is a condition where a pericardial effusion compresses the heart, leading to life-threatening [[acute heart failure]]. This occurs if the pericardial effusion develops rapidly or is large. It’s an emergency which should be treated empirically even before a proper diagnosis is made.
'''Cardiac tamponade''' is a condition where a pericardial effusion compresses the heart, leading to life-threatening [[acute heart failure]]. This occurs if the pericardial effusion develops rapidly or is large. It’s an emergency which should be treated empirically even before a proper diagnosis is made.
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* Metastasis
* Metastasis
* Cardiac wall rupture (trauma, [[Acute myocardial infarction|MI]])
* Cardiac wall rupture (trauma, [[Acute myocardial infarction|MI]])
 
<section end="radiology" />
== Pathomechanism ==
== Pathomechanism ==
In cases where the fluid accumulates quickly, only small amounts of fluids (100-150 mL) are required to cause symptoms. Symptoms occur because the pressure in the pericardial cavity increases, preventing diastolic filling of the heart and causing cardiac tamponade.
In cases where the fluid accumulates quickly, only small amounts of fluids (100-150 mL) are required to cause symptoms. Symptoms occur because the pressure in the pericardial cavity increases, preventing diastolic filling of the heart and causing cardiac tamponade.
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* Jugular venous congestion
* Jugular venous congestion
* <abbr>[[Pulsus paradoxus]]</abbr>
* <abbr>[[Pulsus paradoxus]]</abbr>
 
<section begin="radiology" />
== Diagnosis and evaluation ==
== Diagnosis and evaluation ==
A [[chest x-ray]] may not always show a pericardial effusion. The cardiac shadow may be enlarged. If the effusion is large enough, the heart may appear water bottle-shaped, called "water bottle sign". Echocardiography is the investigation best suited to evaluate pericardial effusion, as it will directly visualise the anechoic fluid around the heart.
A [[chest x-ray]] may not always show a pericardial effusion. The cardiac shadow may be enlarged. If the effusion is large enough, the heart may appear water bottle-shaped, called "water bottle sign". Echocardiography is the investigation best suited to evaluate pericardial effusion, as it will directly visualise the anechoic fluid around the heart.
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** Electrical alternans refers to alternating amplitude (height) of the QRS complex with each heartbeat
** Electrical alternans refers to alternating amplitude (height) of the QRS complex with each heartbeat
* [[Echocardiography]] – large effusion, collapse of chambers, swinging of the heart
* [[Echocardiography]] – large effusion, collapse of chambers, swinging of the heart
 
<section end="radiology" />
== Treatment ==
== Treatment ==
In case of small pericardial effusions, one can watchfully wait for it to either progress or regress. In case of larger effusions, pericardiocentesis is necessary, under [[ultrasound]] or [[Fluoroscopy|fluoroscopic]] guidance.
In case of small pericardial effusions, one can watchfully wait for it to either progress or regress. In case of larger effusions, pericardiocentesis is necessary, under [[ultrasound]] or [[Fluoroscopy|fluoroscopic]] guidance.


Treatment for cardiac tamponade should not be delayed due to diagnostic evaluations. Treatment is by pericardiocentesis. If unsuccessful, surgery may be necessary.
Treatment for cardiac tamponade should not be delayed due to diagnostic evaluations. Treatment is by pericardiocentesis. If unsuccessful, surgery may be necessary.
[[Category:Cardiology]]
<noinclude>[[Category:Cardiology]]
[[Category:Internal Medicine (POTE course)]]
[[Category:Internal Medicine (POTE course)]]‎</noinclude>