Sunitha Daniel
Brief Overview Causes Clinical Presentation Investigations Management Update
Abnormal amount of and/or an abnormal character to fluid in the pericardial space. Normal fluid ml Among malignancies lung-highest prevalance(37%)
Primary 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 alColombo et alSagristà-Sauleda et al Corey et al Effusion> 5 mm> 10 mm Not reported n Tamponade (%)Not reported4437Not reported Idiopathic (%) Chronic idiopathic effusion (%) ??9? Neoplastic (%) Uremia (%) Iatrogenic (%)00160 Post-acute myocardial infarction (%) 0880 Viral (%)14007 Collagen vascular disease (%) Tuberculosis (%)0022 Other (%)942120
Symptoms 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.
Stage 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
Enlarged cardiac silhouette (water- bottle heart) Pericardial fat stripe. Pleural effusion(1/3)
Echo-free space between the visceral and parietal pericardium Small effusions < 10 mm and are generally seen posteriorly Moderate mm and are circumferential. Large :>20 mm
loculated pericardial effusions. CT detects 50ml fluid MRI 30ml fluid. MRI for hemorrhagic and non hemaorrhagic
Based on etiology Medical Surgical
Aspirin/NSAIDs – viral/idiopathic Colchicine –relapsing pericarditis Steroids- systemic inflammation/pregnancy/autoimmune Antibiotics Chemotherapy
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
Pericardiocentesis: idiopathic/viral Indwelling pericardial catheter: neoplastic Percutaneous ballon pericardiotomy Subxiphoid pericardiotomy: purulent Pleuropericardial window Partial pericardiectomy Wide anterior pericardiectomy
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
Diagnosis and management of pericardial effusion World J Cardiol May 26; 3(5): 135–143. Management of pericardial effusion Eur Heart J first published online November 2, 2012 doi: /eurheartj/ehs372 overview