Pericardial effusion

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Background

Sizing (anterior + posterior)

• Small – less than 5 to 10 mm
• Moderate – 10 to 20 mm
• Large – 20 mm or more

Common causes of moderate to large effusions

• Ideopathic
• Neoplastic
• Uremic
• Iatrogenic
• Viral infection
• Collagen vascular disease
• Post radiation
• Post myocardial infarction

Tamponade

Definition

• Pericardial effusion
• Elevated intrapericardial pressure
• Elevated right (or left) atrial pressure
• Normalization of pressures on removal of pericardial fluid

Clinical findings

• Dyspnea
• Tachycardia
• Hypotension
• Jugular venous distention
• Hepatomegally
• Pulsus paradoxicus
• Equalization of diastolic cardiac chamber pressures

Echocardiographic findings

• Diastolic “collapse” of right atrial and/or right ventricular free wall
1. Tamponade is unlikely in the absence of diastolic collapse
2. Diastolic collapse can occur in the absence of tamponade (about 30%)
• Inspiratory fall and expiratory increase in transmitral flow velocity
1. Probably more accurate than diastolic chamber collapse
2. Less widely used clinically

Heart 2001;86:235-240 ( August )