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 • Pericardial effusion

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عدد الرسائل : 307
العمر : 36
العمل/الترفيه : student
علم الدولة : • Pericardial effusion Female14
شعار اداري : • Pericardial effusion Chiefsuperintendent
تكريم : • Pericardial effusion 8744bdd288
   : • Pericardial effusion 15781610
اعلانك هنا : • Pericardial effusion Sp210
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نقاط : 29415
تاريخ التسجيل : 21/04/2008

• Pericardial effusion Empty
مُساهمةموضوع: • Pericardial effusion   • Pericardial effusion Emptyالخميس مايو 08, 2008 12:37 am
Definition

  • Pericardial effusion defines the presence of an abnormal amount and/or character of fluid in the pericardial space. It can be caused by a variety of local and systemic disorders, or it may be idiopathic. Pericardial effusions can be acute or chronic, and the time course of development has a great impact on the patient's symptoms. Treatment varies, and is directed at both removal of the pericardial fluid and alleviation of the underlying cause, which usually is determined by a combination of fluid analysis and correlation with comorbid illnesses.

    Pathophysiology
  • The pericardial space normally contains 15-50 mL of fluid, which serves as lubrication for the visceral and parietal layers of the pericardium. This fluid is thought to originate from the visceral pericardium and is essentially an ultrafiltrate of plasma. Total protein levels are generally low; however, the concentration of albumin is increased in pericardial fluids owing to its low molecular weight.
  • The cause of abnormal fluid production depends on the underlying etiology, but usually it is secondary to injury or insult to the pericardium (ie, pericarditis). Transudative fluids result from obstruction of fluid drainage, which occurs through lymphatic channels. Exudative fluids occur secondary to inflammatory, infectious, malignant, or autoimmune processes within the pericardium.
  • Clinical manifestations of pericardial effusion are highly dependent upon the rate of accumulation of fluid in the pericardial sac. Rapid accumulation of pericardial fluid may cause elevated intrapericardial pressures with as little as 80 mL of fluid, while slowly progressing effusions can grow to 2 liters without symptoms.

    History
  • Cardiovascular

  • Chest pain, pressure, discomfort: Characteristically, pericardial pain may be relieved by sitting up and leaning forward and is intensified by lying supine.
  • Light-headedness, syncope
  • Palpitations
  • Respiratory - Cough, dyspnea, hoarseness
  • Gastrointestinal - Hiccoughs
  • Neurologic - Anxiety, confusion

    Physical

    Cardiovascular
  • Classic Beck triad of pericardial tamponade (hypotension, muffled heart sounds, jugular venous distension)
  • Pulsus paradoxus: Exaggeration of physiologic respiratory variation in systemic blood pressure, defined as a decrease in systolic blood pressure of more than 10 mm Hg with inspiration, signaling falling cardiac output during inspiration.
  • Pericardial friction rub: The most important physical sign of acute pericarditis may have up to 3 components per cardiac cycle and is high-pitched, scratching, and grating. It can sometimes be elicited only when firm pressure with the diaphragm of the stethoscope is applied to the chest wall at the left lower sternal border. The pericardial friction rub is heard most frequently during expiration with the patient upright and leaning forward.
  • Tachycardia
  • Hepatojugular reflux: This can be observed by applying pressure to the periumbilical region. A rise in the jugular venous pressure (JVP) of greater than 3 cm H2O for more than 30 seconds suggests elevated central venous pressure. Transient elevation in JVP may be normal.

    Respiratory
  • Tachypnea
  • Decreased breath sounds (secondary to pleural effusions)
  • Ewart sign - Dullness to percussion beneath the angle of left scapula from compression of the left lung by pericardial fluid

    Gastrointestinal - Hepatosplenomegaly

    Extremities

    • Weakened peripheral pulses

  • Edema
  • Cyanosis
    Causes
    Infectious

  • Viral (coxsackievirus A and B, hepatitis, HIV)
  • Pyogenic (pneumococci, streptococci, staphylococci, Neisseria, Legionella species)
  • Tuberculous
  • Fungal (histoplasmosis, coccidioidomycosis, Candida)
  • Other infections (syphilitic, protozoal, parasitic)
  • Noninfectious
  • Acute idiopathic
  • Uremia
  • Neoplasia
  • Primary tumors (benign or malignant, mesothelioma)
  • Tumors metastatic to pericardium (lung and breast cancer, lymphoma, leukemia)
  • Myxedema
  • Acute myocardial infarction
  • Postirradiation
  • Aortic dissection (with leakage into pericardial sac)
  • Trauma
  • Cholesterol
  • Chylopericardium
  • Familial Mediterranean fever
  • Whipple disease
  • Sarcoidosis
  • Hypersensitivity or autoimmunity related

  • Rheumatic fever
  • Collagen vascular disease (systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, scleroderma, acute rheumatic fever, Wegener granulomatosis)
  • Drug-induced (eg, procainamide, hydralazine, isoniazid, minoxidil, phenytoin, anticoagulants, methysergide)
  • Postcardiac injury
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• Pericardial effusion
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