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Pericardial effusion: Difference between revisions
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<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. | <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, causing the pressure in the pericardial space to exceed the pressure in the heart chambers. It’s an emergency which should be treated empirically even before a proper diagnosis is made. | ||
== Etiology == | == Etiology == | ||
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* Tachycardia | * Tachycardia | ||
* Jugular venous congestion | * Jugular venous congestion | ||
* | * Pulsus paradoxus | ||
Pulsus paradoxus refers to when the systolic blood pressure decreases by more than 10 mmHg during inspirasjon compared to during expiration. This occus because the (physiological) increased filling of the right ventricle impairs the filling of the left ventricle, as the pericardium is non-compliant and therefore prevents the left ventricle from expanding. This can be measured directly with manual blood pressure measurement. The name "paradoxus" comes from the fact that during inspiration the pulse wave amplitude decreases, meansing that during inspiration some beats cannot be felt on the radial pulse. | |||
<section begin="radiology" /> | <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. The effusion is mild when < 10 mm on echo, severe when > 20 mm, and moderate in between. | ||
If cardiac tamponade is suspected based on the clinical features, one should not waste time with time-consuming investigations. A quick echocardiography to confirm pericardial fluid, together with typical clinical features, is usually sufficient to start treatment. | If cardiac tamponade is suspected based on the clinical features, one should not waste time with time-consuming investigations. A quick echocardiography to confirm pericardial fluid, together with typical clinical features, is usually sufficient to start treatment. | ||
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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. | ||
<noinclude>[[Category:Cardiology]] | <noinclude> | ||
[[Category:Internal Medicine (POTE course)]]</noinclude> | [[Category:Cardiology]] | ||
[[Category:Internal Medicine (POTE course)]] | |||
</noinclude> | |||