Pericardial effusion = abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation will lead to an increased intrapericardial pressure and this can negatively affect heart function. When there is a pericardial effusion with enough pressure to adversely affect heart function, this is called cardiac tamponade.
Pericardial effusion may be:
- Transudative: change in osmatic / hydrostatic pressures = congestive heart failure, myxoedema (cutaneous/dermal oedema, secondary to deposition of connective tissue componenets [GAGs/HA]), nephrotic syndrome. Typically: <2g/dL protein. Clear.
- Exudative: infection / inflammation, promoting extravasion from circulation into tissues = tuberculosis, spread from empyema. Typically biochemistry: protein >2.9g/dL. Cloudy.
- Haemorrhagic = trauma, rupture of aneurysms, malignant effusion.
- Malignant = due to fluid accumulation caused by metastasis.
Chest pain, pressure symptoms, muffled heart sounds, pulsus paradoxus, (pulse that CAN be auscultated but CANNOT be palpated- at radial pulse). A small effusion may have no symptoms.
CXR: ‘water bottle’ heart / ‘large globular heart’ = cardiopericardial sillouette is enlarged.
- Pericarditis (pericardial effusioncaridac tamponadecardiogenic shockcardiac arrest)!
- Viral infection (coxsackie B-virus): myocarditis, pericarditis, effusions
- Inflammatory disorders, such as SLE and post myocardial infarction pericarditis (Dressler’s syndrome)
- Cancer that has spread to the pericardium = malignant effusion
- Trichinosis = parasitic infection caused by trichinella spiralis
- Kidney failure with excessive blood levels of urea nitrogen (uraemia)
- Minoxidil = potent vasodilator originally used for HTN – now used to stop hair loss (s/e: hyertrichosis)
- Heart surgery – repair of ASD: common setting for tamponade (24-48h post op)
Hereditary? Infective? How does it spread?
Treatment and management (conservative/medical/surgical)
Can be left to resolve spontaneously, or if causing cardiac compromise, will require emergency drainage (=pericardiocentesis).