PERICARDIAL EFFUSION AND CARDIAC TAMPONADE Sunitha Daniel
Dec 16, 2015
OVERVIEW Abnormal amount
of and/or an abnormal character to fluid in the pericardial space.
Normal fluid 15-50ml
Among malignancies lung-highest prevalance(37%)
CAUSESPrimary Acute
inflammatory pericarditis (infectious-viral(HIV),bacterial,fungal autoimmune)
Previously unknown neoplasia
Idiopathic
Secondary Acute MI Cardiac surgery Trauma Metastasis Chest irradiation End-stage renal failure Hypothyroidism Autoimmune diseases Pulm HTN Chylopericardium Drugs : procainamide,
hydralazine, INH, minoxidil, phenytoin, anticoagulants
Corey et al Colombo et al Sagristà-Sauleda et al
Corey et al
Effusion > 5 mm > 10 mm > 10 mm Not reported
n 57 25 322 106
Tamponade (%) Not reported 44 37 Not reported
Idiopathic (%) 7 32 20 25
Chronic idiopathic effusion (%)
? ? 9 ?
Neoplastic (%) 23 36 13 37
Uremia (%) 12 20 6 4
Iatrogenic (%) 0 0 16 0
Post-acute myocardial infarction (%)
0 8 8 0
Viral (%) 14 0 0 7
Collagen vascular disease (%)
12 0 5 5
Tuberculosis (%) 0 0 2 2
Other (%) 9 4 21 20
CLINICAL FEATURESSymptoms Chest pain. Syncope Palpitations Cough Dyspneoa Hoarseness
Signs Beck triad Pulsus paradoxus Pericardial friction rub Tachycardia Hepatojugular reflux Tachypnea Decreased breath
sounds Ewart sign Weakened peripheral
pulses, edema, and cyanosis.
ECGStage I - Diffuse ST-
segment elevation and PR-segment depression
Stage II - Normalization of the ST and PR segments
Stage III - Widespread T-wave inversions:
Stage IV - Normalization of the T waves
ECHOCARDIOGRAPHY Echo-free space
between the visceral and parietal pericardium
Small effusions < 10 mm and are generally seen posteriorly
Moderate 10-20 mm and are circumferential.
Large :>20 mm
CT &MRI loculated
pericardial effusions.
CT detects 50ml fluid
MRI 30ml fluid. MRI for
hemorrhagic and non hemaorrhagic
MEDICAL Aspirin/NSAIDs – viral/idiopathic Colchicine –relapsing pericarditis Steroids- systemic
inflammation/pregnancy/autoimmune Antibiotics Chemotherapy
INDICATIONS FOR PERICARDIAL DRAINAGE PROCEDURES Diagnostic or therapeutic purposes Not routinely for diagnosis-poor yield. Strong suspicion of purulent or
tuberculous pericarditis. Malignancy Asymptomatic patients with massive
idiopathic chronic pericardial effusion
PROCEDURES OF PERICARDIAL DRAINAGE
Pericardiocentesis: idiopathic/viral Indwelling pericardial catheter:
neoplastic Percutaneous ballon pericardiotomy Subxiphoid pericardiotomy: purulent Pleuropericardial window Partial pericardiectomy Wide anterior pericardiectomy
NEOPLASTIC PERICARDIAL INVOLVEMENT relapses in as many as 40%-50% of
patients terminal patients-pericardiocentesis
alone patients with a longer expected survival-
Indwelling pericardial catheters( 75% success rate)
Balloon pericardiotomy