Accumulation of excess fluid in the pericardial sac is called pericardial effusion. The normal pericardial sac contains about 50 ml of fluid).
Causes: According to the character of fluid-
- Purulent/suppurative: Pygenic bacterial and viral causes.
- Serous: CCF, hypoprotenaemia, cirrhosis of liver Myxoedema/Nephrotic syndrome.
- Haemorrhage: Malignancy, Tuberculous, Traumatic (rarely)
Types: It may be:
- transudative (congestive heart failure,myxoedema, nephrotic syndrome)
- exudative (tuberculosis, spread from empyema )
- haemorrhagic (trauma, rupture of aneurysms, malignant effusion).
- malignant (due to fluid accumulation caused by
- Central chest pain (initially):
- Pain increased in leaning forward.
- Disappears when pericardial effusion develops.
- Further symptoms develops on the amount of fluid and rapidity of collection of fluid-
- Heaving of chest.
- Dyspnoea on exertion.
- Features of the cause.
- Pulse: Pulse paradoxus, low volume tachycaadia.
- BP: Usually low.
- JVP: Raised with sharp descend of ‘y’ wave.
- Dependent oedema (present if constrictive pericarditis)
- Apex beat-Not palpable.
- Percussion note: Area of cardiac dullness increased.
- Auscultation-Heart sounds are feeble.
- Signs of underlying cause.
- Pericardial friction rub may present in early cases without temponade.
- Blood for TC, DC, ESR, Hb%.
- X-ray chest P/A view (serial radiography may show)
- Rapid increased in the size of cardiac shadow.
- Heart is globular or pear shaped (in large effusion)
- ECG: Low voltage.
- Fluoroscopy: Non pulsatile enlarged cardiac shadow.
- Paracentasis of pericardial fluid.
- Symptomatic treatment: Rest, diuretics, analgesic.
- Pericardial effusion without temponade: No specific treatment.
- Pericardial effusion with temponade: Paracentasis (the fluid is aspirated by introducing a needle just medial to the cardiac apex or by inserting a needle below the xiphoid process and directed towards the left shoulderly.
- Surgical drainage: If viscous, loculated or recurrent effusion.
- Davidson’s Principles and Practice of Medicine, 21st
- Kumar and clark Medicine, 7th
- Wikipedia free encyclopedia.