Pericardial Effusion/tamponade

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

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Basics

Description

  • 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

Etiology

  • 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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Basics

Description

  • 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

Etiology

  • 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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