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

Clinical Features

1. Rapidity of fluid accumulation determines signs/symptoms
   1. CP, SOB, fatigue
   2. CHF-type appearance
   3. Narrow pulse pressure
   4. Friction rub
   5. Beck's Triad (30% of pts)
      1. Hypotension, muffled heart sounds, JVD

Diagnosis

1. Pulsus paradoxus
   1. >10mmHg change in sys BP on inspiration
2. Ultrasound
   1. RV collapse, effusion
3. 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. IVF to increase RV volume
2. Pressors (temporizing)
3. AVOID preload reducing meds (nitrates, diuretics)
4. Procedures
   1. Pericardiocentesis
   2. Pericardial window (OR)

Disposition

1. Likely ICU
2. Cardiology, CT surgery consultations

See Also

• Pericarditis
• Cardiac Tamponade

Source

Tintinalli