Pericardial Effusion/tamponade

Basics

Pericardial effusion:
- Pericardial sac usually contains 15–40 cc of fluid
- Collection of additional fluid = effusion
Pericardial tamponade:
- Accumulation of pericardial fluid causes an elevation of pressure in the pericardial space, resulting in impairment of ventricular filling and decreased cardiac output
- Depends on size and speed of fluid accumulation
- Increase of as little as 80–120 cc of fluid may lead to a rise in pericardial pressure
- Up to 70% present in “early tamponade” and appear clinically stable
- Occurs in 2% of patients with penetrating chest trauma

Medical causes:
- Pericarditis (20%):
  - 90% idiopathic or viral
  - Bacterial, fungal, parasitic, tuberculosis, HIV
- Malignancy (13%):
  - Lymphoma, leukemia, melanoma, breast, lung
  - Metastatic disease, primary malignancy, postradiation
- Postmyocardial infarction (8%):
  - Acute: 1–3 d after acute myocardial infarction (AMI)
  - Subacute (Dressler syndrome): Weeks to months after AMI
  - Incidence reduced with reperfusion therapy
- End-stage renal disease, uremia (6%)
- Autoimmune/collagen vascular disease (5%): Rheumatoid arthritis, systemic lupus erythematosus, scleroderma
- Rheumatic fever
- Radiation therapy
- Myxedema
- Congestive heart failure (CHF), valvular heart disease
- Drug toxicity (isoniazid, doxorubicin, procainamide, hydralazine, phenytoin)
- Idiopathic
Surgical causes:
- Penetrating chest trauma
- Thoracic aortic dissection
- Iatrogenic (cardiac catheterization, postcardiac surgery, central line placement)
- Blunt trauma rarely causes pericardial effusion

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