Post Number 4: Pericardial Effusion

Pericardial Effusion with Tamponade. The heart (the structure moving back and forth horizontally) is "suspended" from the excess of fluid around it. This phenomena is called the "Swinging Heart".

            Pericardial effusion (fluid around the heart) can be caused from factors ranging from illnesses to traumas to the chest. If not monitored and treated quickly, pericardial effusion can lead to Cardiac Tamponade which is a life-threatening condition that occurs when the effusion compresses the heart. Because many trauma patients are at risk of pericardial effusion, being able to image the chest quickly is imperative. Because ultrasounds have no radiation, are non-invasive to the patient and produced quickly, bedside Echocardiography (a heart ultrasound) has become the go to procedure for checking patients for pericardial effusion. Before echocardiographs, Cardiac Tamponade was usually diagnosed by Beck’s Triad—muffled heart sounds, jugular venous distention (vein looks protruded), and hypotension (low blood pressure); however, physicians soon realized that pericardial effusion could still occur without these symptoms.

What is Pericardial Effusion?

            To give some background, pericardial effusion occurs between the pericardium (a sac/lining around the heart) and the heart itself. Normally, there is a miniscule amount of fluid between the pericardium and the heart that allows the heart to lubricate the hearts beating movement. Pericardial effusion occurs when too much fluid accumulates and compresses the heart, decreasing heart function.

            An ultrasound of the heart can help physicians measure the amount of effusion (fluid) around the heart. Here are the measurements that determine the size of the effusion:

1. Small effusion: <0.5cm (roughly corresponds to <100cc)

2. Moderate effusion: 0.5cm-2cm (roughly corresponds to 100-500cc)

3. Large effusion: >2.0 cm (roughly corresponds to >500cc)

*note: cc stands for cubic centimeters. 1 cc (cubic centimeter) =1 milliliter (1mL)

            Even though it is important to measure the size of a pericardial effusion, physicians focus mainly on the rate of fluid accumulation rather than the size of an effusion because a large effusion can sometimes exert very little pressure on the heart while a small effusion can exert a large amount of pressure.

Ultrasound Example Images:

           

The traditional echocardiographic views of the heart

Pericardial effusion with early tamponade. The right atrium is noted to have diastolic collapse. RV, right ventricle; RA, right atrium; LV, left ventricle; LA, left atrium

 Treatment:

Treatment options for pericardial effusion can include anti-imflamatory drugs (helps the pericardium stop swelling), treating the underlying cause (curing the patients infection) and ultrasound-guided pericardiocentesis (A doctor uses ultrasound imaging to insert a needle into the patient’s chest and removes the excess fluid around the heart)

Sources:

1. Goodman, Adam et al. “The Role of Bedside Ultrasound in the Diagnosis of Pericardial Effusion and Cardiac Tamponade.” Journal of Emergencies, Trauma, and Shock 5.1 (2012): 72–75. PMC. Web. 25 Mar. 2015.