Pericardial Effusion Pericardial EffusionPericardial EffusionPericardial EffusionPericardial EffusionPericardial EffusionPericardial EffusionPericardial Effusion

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PERICARDIAL EFFUSION

Present by:

Sharifah Faseha

Supervisor:

dr. Abdul Hakim Alkatiri, SpJP.FIHA

Cardiology Department

Medical Faculty

Hasanuddin University

Case Report

2013


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History Taking

Chief complaint: Shortness of breath

Further anamnesis: It was felt since 3 days

before she was admitted to the hospital.

Dyspnea (+), DOE(+), PND (+), Orthopnea(+),

chest pain(+) occur along with SOB.nausea(-),

vomiting (-), fever(-) Urination and defecation

were normal.


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History of past illness

History of hypertension (-)

History of Diabetes Mellitus (-)

History of heart disease (-) Family history of heart disease (-)

History of breast cancer (+) undergone total

right mastectomy


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Clinical Examination

General condition:

moderate illness/ normal weight/ conscious

Vital Sign

BP: 120/80 mmHg R : 26x/minHR: 88 bpm T : 36,8oC (afebrile)

Head: anemia (-), jaundice (-)

Neck: JVP R+3cm H20

Lung: BS: bronchovesicular

Rh -/- basal Wh -/-


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Cardiac Examination

Inspection : Ictus cordis wasntvisible

Palpation : Ictus cordis wasntpalpable.

Percussion : Right heart border in right

parasternalis line, left heart border one finger

from left midclavicle line ICS V.

Auscultation : Heart Sounds = S I/II regular.


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Abdominal Examination

Inspection : Flat, following breath movement

Auscultation : Peristaltic sound (+), normal

Palpation : Liver and spleen are unpalpable Percussion : Tympani (+)

Extremities

Oedema pretibial -/-

Oedema dorsum pedis -/-

Cyanosis (-), Clubbing finggers (-)


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Electrocardiogram on 25th April 2013


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ECG Interpretation

Rhythm : Sinus Rhythm

HR / QRS rate : 100bpm

Axis : Normoaxis

Regularity : Regular

P wave : 0,08 s

PR interval : 0,12 s

QRS complex : 3 small squares (0,12 s)

ST segment : Normal

Conclusion : Sinus rhythm, HR 100bpm, normoaxis


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Laboratory Findings

Test Result Normal Value

WBC 7,75 [10^3u/L] 4,010,0

RBC 4,38 [10^6u/L] 4,06,0

HGB 11,4 [g/dL] 13,017,0

HCT 35,9 [%] 40,054,0

PLT 309 [10^3u/L] 150 - 500

Ureum 14 [mg/dL] 10 - 50

Creatinine 0,6 [mg/dL] M(


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Chest X-Ray

Duplex pulmonarytuberculosis

Cardiomegaly with

dilatation of aorta


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Echocardiogram


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Echocardiogram description

Good LV systolic function. EF 81%

Hyperkinetic

RA.RV collapse

Heart valves : Mitral: Good function and movement

: Aorta : 3cuspis. Calcification (-).Good function and movement

: Tricuspid : Good function andmovement

: Pulmonal : Good function andmovement

Conclusion : Impending cardiac temponade


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Working Diagnosis

Pericardial Effusion


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Therapy

IVFD Nacl 0,9% 500cc

Ceftriaxone 2gr/24hrs/iv (antibiotic)

Pericardiocenthesis


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Planning

Cytology analysis of pericardial fluid


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DISCUSSION

PERICARDIAL EFFUSION


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Pericardium

Fibrous sac surrounding heart-dense network ofcollagen fibres

Serous membranetwo continuous layersseparated by a small amount of fluid lubricant (30-50mls straw coloured (serous fluid))

Layers are called visceral and parietal Visceral is inner layer (epicardium)

Parietal is continuous with diaphragm and outer walls ofgreat arteries

Surrounds the heart Continuous with the great arteries and the

diaphragm


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What is its function?

Stabilises the position of the heart within the

chest

Prevents friction between the moving heart

and adjacent structures


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Pericardial effusion

Pericardial effusion("fluid around the heart")

is an abnormal accumulation of fluid in

the pericardial cavity. Because of the limited

amount of space in the pericardialcavity, fluid accumulation leads to an

increased intrapericardial pressure which can

negatively affect heart function.


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Causes

Infective (viral or bacterial)

Following a myocardial infarction or cardiac surgery

Radiation therapy

Neoplastic disease (commonly lung or breast)


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Pathophysiology

Inflammation of pericardium due to infectionmetastasis process or lymphatic obstruction

Disturb the equilibrium between the production and

re-absorption of pericardial fluid

Pericardium exude fluid, fibrin, blood cells.

Increases fluid volume in pericardial space

Pericardial effusion


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Investigations and clinical signs

Clinical examinationSOB, orthopnoea, tachycardia(varying degrees)

Auscultationmay have muffled heart sounds

ECG may show low amplitude QRS complexes and

alternating axis CXRglobular appearance to heart and therefore

increased cardiothoracic ratio

Echosize of effusion and haemodynamic effect of it


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CXR

Being describe aswater bottle heart

shape

Widening of cardiac

sillhoutte


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Echocardiogram


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Treatment

Depends on the underlying cause and the severity of theheart impairment.

If the pericardial effusion is due to a condition such as lupus,

treatment with anti-inflammatory medications may help.

If the effusion is compromising heart function and causingcardiac tamponade, it will need to be drained, most

commonly by a needle inserted through the chest wall and

into the pericardial space called pericardiocentesis.

In some cases, surgical drainage may be required by cuttingthrough the pericardium creating a pericardial window, which

allows ongoing drainage of fluid externally or internally such

as into the pleural cavity


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Additional info

Pericardial effusion develops in 5% to 15% of patients withcancer and is sometimes the initial manifestation ofmalignancy.

Most pericardial effusions in cancer patients result fromobstruction of the lymphatic drainage of the heartsecondary to metastases.

The typical presentation is that of a patient with knowncancer who is found to have a large pericardial effusionwithout signs of inflammation.

The most common malignant causes of pericardialeffusions are lung and breast cancers, leukemias(specifically acute myelogenous, lymphoblastic, and chronicmyelogenous leukemia [blast crisis]), and lymphomas.

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