Cardiothoracic Surgery: Pericardial Effusion & Cardiac Tamponade

Pericardial Effusion

Causes

  • Idiopathic
  • Malignancy
  • Uremia
  • Iatrogenic
  • Traumatic
  • Post Myocardial Infarction
  • Acute Pericarditis

Presentation

  • Most are Asymptomatic if Not Hemodynamically Significant
  • Can Cause Pericardial Tamponade & Hemodynamic Instability
  • EKG Findings:
    • Sinus Tachycardia
    • Low QRS Voltage
    • Electrical Alternans – Cyclic Beat-to-Beat Shift in the QRS Axis from Mechanical Swinging of the Heart within a Large Effusion

Diagnosis

  • Diagnosis: Echocardiogram
  • CT or MRI May Be Useful if Echocardiogram is Non-Diagnostic

Size

  • Small: < 100 cc (< 10 mm Thick on Echo)
  • Moderate: 100-500 cc (10-20 mm Thick on Echo)
  • Large: > 500 cc (> 20 mm Thick on Echo)

Treatment

  • Cardiac Tamponade: Urgent Drainage
    • *See Below
  • Indication for Diagnostic Fluid Sampling:
    • Suspected Bacterial or Tuberculosis Pericarditis
    • Suspected Neoplastic Pericarditis
    • Large Chronic (> 3 Months) Idiopathic Effusion
    • Symptomatic Moderate-Large Effusion that Fails Medical Therapy
  • Small-Moderate Effusion without Need for Diagnostic Sampling: Serial Exams & Echocardiograms

Cardiac Tamponade

Definition

  • Cardiac Filling Impeded by Pericardial Fluid
  • Can Occur with Only A Small Amount of Fluid

Phases

Presentation

Diagnosis

Treatment

  • Traumatic Cardiac Tamponade:
  • Non-Traumatic Cardiac Tamponade:
    • Pericardiocentesis Indications:
      • Hemodynamic Instability
      • Idiopathic Etiology
    • Sternotomy Indications:
      • Need for Biopsy
      • Effusion Small or Loculated
      • Purulent Effusion
      • Coagulopathic
      • Recurrent Effusion