TOC | Cardiology   
PERICARDIAL EFFUSION

DX (esp. of cardiac tamponade):

• Low cardiac output Sx: dyspnea, tachycardia, hypotension, jugular vein distension, decreased heart sounds, paradoxical pulse >10 mmHg, Kussmaul's sign (rise in venous pulse with inspiration)
• EKG may show electrical alternans, & decreased QRS voltage
• Chest x ray may show cardiomegaly
• Echocardiogram & CT scan will show pericardial effusion & thickening
• Cardiac catheterization may show equalization of pulmonary wedge pressure with the RA, RV, & pulmonary artery diastolic pressure, & also the "square root" sign in the ventricular pressure pulses.

RX:  Immediate pericardiocentesis may be lifesaving in cardiac tamponade !

Types of Pericardial Effusion:

• A. Serous type: CHF, Hypoalbuminemia, Post thoracic irradiation, Viral or idiopathic pericarditis
• B. Serofibrinous or serosanguineous: Neoplastic, Infectious, Uremic, Taumatic, Systemic lupus pericarditis
• C. Hemorrhagic type: Post cardiac surgery, Post MI + anticoagulants, Trauma, Vascular pericardial tumors
• D. Chylous type: Idiopathic, Post cardiac surgery, Neoplastic pericarditis with lymphatic obstruction
• Lymph obstruction by intrathoracic masses