Pericardial Effusion: Causes, Identification, and Management

Introduction

• Pericardial Effusion: Condition where fluid builds up around the heart.
• Can lead to serious complications like cardiac tamponade.
• Lecture by Eddie Watson aims to simplify complex ICU topics.

Anatomy of the Heart

• Pericardial Sac: Surrounds the heart, composed of two layers:
  • Visceral Pericardium: Thin layer adhering to the heart, smooth surface for movement.
  • Parietal Pericardium: Thick, fibrous outer layer, provides protection.
• Pericardial Space: Filled with 15-50 mL of serous fluid for cushioning and lubrication.

Pathophysiology of Pericardial Effusion

• Causes: Acute or chronic fluid accumulation in the pericardial sac.
• Types of Effusions:
  • Transudative: Due to increased hydrostatic or decreased oncotic pressure. Fluid is clear and low in protein.
    • Causes: Congestive heart failure, liver cirrhosis, hypoalbuminemia, kidney failure.
  • Exudative: Due to inflammatory or infectious processes, or bleeding. Fluid is cloudy, high in protein.
    • Causes: Infections (bacterial, viral), inflammatory diseases (pericarditis, autoimmune disorders), cancers, trauma.

Symptoms and Diagnosis

• Symptoms: Vary based on effusion size, speed of accumulation, and cause.
  • Common: Dyspnea, chest discomfort, orthopnea, dry cough, hoarseness, dysphagia, fatigue, syncope, edema.
• Physical Signs: Muffled heart tones, electrical alternans on EKG, pulsus paradoxus.
• Diagnosis Tools:
  • Echocardiography: Gold standard for diagnosis.
  • CT/MRI: Less informative, helps identify large effusions.
  • Chest X-ray: May show enlarged cardiac silhouette.
  • EKG: Shows electrical alternans, low voltage.

Management and Treatment

• Observation: Small, asymptomatic effusions may resolve untreated.
• Intervention Needed:
  • Presence of cardiac tamponade symptoms.
  • Large or rapidly progressing effusions.
  • Persistent symptoms despite conservative management.
  • Malignant or recurrent effusions.
• Drainage Methods:
  • Pericardiocentesis: Needle insertion to drain fluid, guided by echocardiography.
  • Pericardial Drain or Window: For continuous drainage in recurrent cases.
  • Surgical Interventions: Required in the case of bleeding or persistent effusions.

Conclusion

• Understanding anatomy, pathophysiology, and management of pericardial effusion is crucial.
• Proper intervention can prevent severe complications like cardiac tamponade.