PAINE Podcast and Medical Blog

#26 – Pericardial Effusion and Cardiac Tamponade

Wrinkled Parchment Paper



The pericardium consists of a double-layered semi-elastic sac that holds the heart in the mediastinum.  Basically, so the heart doesn’t flop around inside the thoracic cavity.  There should be a small amount of fluid (15-50mL) present to prevent adhesion of the pericardial sac to the heart.  It is then termed an effusion when it is more than the normal amount.  How much quantifies an effusion?  Doesn’t matter…. what does matter is how fast that fluid develops.  Because the pericardium is semi-elastic, it can accommodate and stretch over time if the accumulation is slow.  This would lead to a greater volume of fluid before symptoms occur.  If the fluid accumulates rapidly, less volume can produce profound effects due to the restrictive nature of the fibrous pericardium.


Signs and Symptoms

There are no reliable historical clues or physical exam findings that are specific to pericardial effusions.  They are helpful, though, to sort out the cause of the effusion. Common findings include:




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