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Pericardial Effusion/tamponade

Pericardial Effusion/tamponade is a topic covered in the 5-Minute Emergency Consult.

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  • 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 days 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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Rosen, Peter, et al., editors. "Pericardial Effusion/tamponade." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307309/all/Pericardial_Effusion_tamponade.
Pericardial Effusion/tamponade. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307309/all/Pericardial_Effusion_tamponade. Accessed April 25, 2019.
Pericardial Effusion/tamponade. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307309/all/Pericardial_Effusion_tamponade
Pericardial Effusion/tamponade [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307309/all/Pericardial_Effusion_tamponade.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pericardial Effusion/tamponade ID - 307309 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307309/all/Pericardial_Effusion_tamponade PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -