Pericardial effusion and tamponade

Pathophysiology

• Incr pericardial P > decr diastolic filling > collapse of RA

Etiology

1. Metastatic malignancy
2. Pericarditis
3. Uremia
4. Hemorrhage (anticoagulant)
5. Other (SLE, postradiation, myxedema)

DDx

1. Tension PTX
2. PE
3. SVC syndrome
4. large pleural effusion
5. Tension pneumocardium
6. Constrictive pericarditis
7. Cardiogenic shock

Diagnosis

1. Rapidity of fluid accumulation determines clinical effects
2. Symptoms
   1. CP, SOB, fatigue
   2. CHF-type appearance
3. Signs
   1. Narrow pulse pressure
   2. Friction rub
   3. Beck's Triad (30% of pts)
      1. Hypotension, muffled heart sounds, JVD
   4. Pulsus paradoxus
      1. >10mmHg change in sys BP on inspiration
   5. Ultrasound
      1. RV collapse, effusion
   6. ECG
      1. Normal or low voltage
      2. Electrical alternans

Work-Up

1. ECG
2. CXR
3. CBC, chem 10, coags, troponin
   1. consider ANA, ESR, RF, PPD
4. Ultrasound
5. Pericardial fluid
   1. Send for viral/bact Cx, cell count, cytology

Treatment

1. IV fluids to incr RV vol
2. Pressors (temporizing)
3. AVOID preload reducing meds (e.g. nitrates, diuretics)
4. Procedures
   1. Pericardiocentesis
   2. Pericardial window (OR)

Disposition

1. Likely ICU
2. Cards, CT surg consults

See Also

Pericarditis

Source

Tintinalli