II. Definition
- Fluid collection around heart within pericardial sac
III. Causes
- Benign Pericarditis
- Malignant Pericarditis (common, occurs in 20-40% of cancer patients)
- Also occurs as a complication of combination Chemotherapy, Radiation Therapy
- Most common metastatic cancer causes
- Other cancer causes
- Hemopericardium
- Heart surgery from post-operative Hemorrhage (common)
- Myocardial Infarction (free wall ventricular rupture)
- Aortic aneurysm
- Aortic Dissection
- Chest Trauma (especially penetrating Chest Injury)
- Anticoagulation
- Chylopericardium (milky Pericardial Effusion)
- Heart surgery from post-operative lymph collection
- Malignancy (lymphatic obstruction from heart)
IV. Symptoms: Symptoms
- Symptomatic threshold for Pericardial Effusion
- Acute (rapidly progressive): 200 ml
- Chronic: May not be significantly symptomatic until 1-2 Liters are present
- Common Symptoms
- Chest Pain
- Shortness of Breath (especially exertional Dyspnea)
- Palpitations
V. Signs
- See Cardiac Tamponade
-
Pulsus Paradoxus
- Occurs in 77% of Cardiac Tamponade cases
- Beck Triad (more common in rapidly progressive Pericardial Effusions)
- Muffled heart sounds
- Hypotension
- Jugular Venous Distention
VI. Diagnostics: Electrocardiogram
- See Cardiac Tamponade
- Low amplitude wave forms
- Electrical alternans
VII. Imaging: Echocardiogram
- See Echocardiogram
- Features
- Pericardial Effusion will surround the heart and should be seen in multiple views
- Pericardial fluid moves in opposite direction as heart wall
- Cardiac Tamponade
- Right heart wall movement appears as a paradoxical rocking motion
- Right atrium collapse in systole (also occurs with Hypovolemic Shock)
- Right ventricular collapse in diastole
- May appear as a tiny man jumping on right ventricle like a trampoline (PLAX View)
- Differential diagnosis (look-alikes on Echocardiogram, confirm in multiple views)
- Descending aorta
- Pericardial fat pad (moves with heart wall)
- Clotted blood may have similar heterogeneous appearance as fat
- However clotted blood moves independently of heart wall
- Precautions
- Even a small Pericardial Effusion (0.5 cm) can cause tamponade
- References
- Mateer and Jorgensen (2012) Introduction and Advanced Emergency Medicine Ultrasound Conference, GulfCoast Ultrasound, St. Pete's Beach
- Orman, Dawson and Mallin in Majoewsky (2013) EM:Rap 13(1): 4-6
VIII. Management
- Consult cardiothoracic surgery
- Emergent management for Cardiac Tamponade
- Chronic management
- Pericardial window
- Pericardiocentesis with indwelling pericardial catheter drainage
- Specific cause management (e.g. Chemotherapy)
- Consult oncology, Palliative Care when appropriate
IX. Prognosis
- Malignant Pericardial Effusion
- Median survival: 2-4 months
X. References
- Long, Long and Koyfman (2020) Crit Dec Emerg Med 34(11): 17-24
- Higdon (2018) Am Fam Physician 97(11):741-8 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI_CTCAE) | A disorder characterized by fluid collection within the pericardial sac, usually due to inflammation. |
| Definition (NCI_CDISC) | Fluid collection within the pericardial sac, usually due to inflammation. (NCI) |
| Definition (NCI) | Fluid collection within the pericardial sac, usually due to inflammation. |
| Definition (NCI_NCI-GLOSS) | An abnormal collection of fluid inside the sac that covers the heart. |
| Definition (MSH) | Fluid accumulation within the PERICARDIUM. Serous effusions are associated with pericardial diseases. Hemopericardium is associated with trauma. Lipid-containing effusion (chylopericardium) results from leakage of THORACIC DUCT. Severe cases can lead to CARDIAC TAMPONADE. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D010490 |
| SnomedCT | 70370001, 373945007 |
| English | Effusions, Pericardial, Pericardial Effusion, Pericardial Effusions, Effusion, Pericardial, Pericardial effusions, pericardial effusion (diagnosis), pericardial effusion, Effusion pericardial, Pericardial Fluid, Pericardial Effusion [Disease/Finding], pericardial effusions, effusion pericardial, Fluid in pericardium, PERICARDIAL EFFUSION, FLUID, PERICARDIAL, Pericardial effusion (disorder), effusion; pericardial, effusion; pericardium, pericardium; effusion, Pericardial effusion, NOS, Pericardial effusion |
| Portuguese | DERRAME PERICARDICO, Derrame pericárdico, Derrame Pericárdico |
| Spanish | DERRAME PERICARDICO, derrame pericárdico (trastorno), derrame pericárdico, Derrame pericárdico, Derrame Pericárdico |
| Japanese | 心嚢液貯留, ｼﾝﾉｳｴｷﾁｮﾘｭｳ |
| Swedish | Perikardiell utgjutning |
| Czech | perikardiální efúze, Perikardiální výpotek, Výpotek perikardiální |
| Finnish | Perikardiumeffuusio |
| Russian | PERIKARDIAL'NYI VYPOT, GEMOPERIKARD, ГЕМОПЕРИКАРД, ПЕРИКАРДИАЛЬНЫЙ ВЫПОТ |
| French | EFFUSION PERICARDIQUE, Epanchement péricardique, Épanchement péricardique |
| German | PERICARDIALERGUSS, Perikarderguss, Herzbeutelerguß, Perikarderguß |
| Polish | Wysięk osierdziowy, Krwiak osierdzia |
| Hungarian | Pericardialis fluidum, Pericardialis effusio |
| Norwegian | Perikardial effusjon, Perikardial lekkasje |
| Dutch | effusie; pericard, pericard; effusie, vochtophoping; pericard, pericardeffusie, Effusie, pericard-, Pericardeffusie |
| Italian | Versamento pericardico |
