PAINE Podcast and Medical Blog

#26 – Pericardial Effusion and Cardiac Tamponade

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Anatomy

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.


Etiology


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:


Work-Up


Treatment


References

  1. Braunwald E. Pericardial Disease. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2015. http://accessmedicine.mhmedical.com/content.aspx?bookid=1130&Sectionid=79743215. Accessed January 12, 2017.
  2. Imazio M. Contemporary management of pericardial diseases. Current Opinion in Cardiology. 2012;27(3):308-17. [pubmed]
  3. Levy PY, Corey R, Berger P. Etiologic diagnosis of 204 pericardial effusions. Medicine. 2003;82(6):385-91. [pubmed]
  4. Permanyer-Miralda G. Acute pericardial disease: approach to the aetiologic diagnosis. Heart (British Cardiac Society). 2004;90(3):252-4. [pubmed]
  5. Bruch C, Schmermund A, Dagres N. Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment. Journal of the American College of Cardiology. 2001;38(1):219-26. [pubmed]
  6. Sternbach G. Claude Beck: cardiac compression triads. The Journal of Emergency Medicine. 1989;6(5):417-9. [pubmed]
  7. Stanford University. Tamponade. Echocardiography in ICU. https://web.stanford.edu/group/ccm_echocardio/cgi-bin/mediawiki/index.php/Tamponade.
  8. Adler Y, Charron P, Imazio M. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2015;36(42):2921-64. [pubmed]
  9. Gumrukcuoglu HA, Odabasi D, Akdag S, Ekim H. Management of Cardiac Tamponade: A Comperative Study between Echo-Guided Pericardiocentesis and Surgery-A Report of 100 Patients. Cardiology Research and Practice. 2011:197838. [pubmed]