Overview
Definition
Accumulation of fluid in the pericardial space resulting in increased pressure, restricted ventricular filling, and decreased cardiac output.
Epidemiology
A medical emergency. Can result from trauma, malignancy, or progression of pericarditis.
Etiology & Risk Factors
- Malignancy (most common medical cause)
- Trauma (penetrating chest wound)
- Aortic dissection
- Pericarditis complication
- Iatrogenic (post-cardiac surgery/procedure)
Clinical Symptoms
- Dyspnea
- Tachycardia
- Shock / Hypotension
Clinical Approach
Diagnosis
- Beck's Triad: Hypotension, Jugular Venous Distension (JVD), Muffled heart sounds
- Pulsus paradoxus (drop in systolic BP > 10 mmHg on inspiration)
- Echocardiogram (Right ventricular diastolic collapse, plethoric IVC)
- ECG: Electrical alternans (QRS amplitude varies beat to beat)
Management
- Immediate Pericardiocentesis (needle aspiration of fluid)
- IV Fluids (temporizing measure to increase right-sided filling pressures)
- Surgical pericardial window (for recurrent/malignant effusions)
Complications
- Cardiogenic shock
- Cardiac arrest (PEA)
- Death