Derrame Pericárdico

Question 1

Causas gerais

Answer 1

Any pathological process usually causes an inflammation with
the possibility of increased production of pericardial fluid (exudate).
An alternative mechanism of accumulation of pericardial fluid may
be decreased reabsorption due to a general increase in systemic
venous pressure as a result of congestive heart failure or pulmonary
hypertension (transudate)

Question 2

Classificação

Answer 2

Pericardial effusion may be classified
according to its onset (acute or subacute vs. chronic when lasting
.3 months), distribution (circumferential or loculated), haemo-
dynamic impact (none, cardiac tamponade, effusive-constrictive),
composition (exudate, transudate, blood, rarely air, or gas from bac-
terial infections) and, in particular, by its size based on a
simple semiquantitative echocardiographic assessment as mild
(,10 mm), moderate (10–20 mm) or large (.20 mm)

Question 3

Etiologias mais comuns em paises desenvolvidos e no BR

Answer 3

idiopathic in developed countries (up to 50%), while other common
causes include cancer (10–25%), infections (15–30%), iatrogenic
causes (15–20%) and connective tissue diseases (5–15%), whereas
TB is the dominant cause in developing countries (.60%), where
TB is endemic

Question 4

Correlação clínica com velocidade de acumulação de fluido pericardico

Answer 4

If pericardial fluid is rapidly accumulating, such as after wounds or iatrogenic perforations, the evolution is dramatic and even small amounts of blood may cause an increase in intrapericardial pressure within minutes and overt cardiac tamponade. On the other hand, a slow accumulation of pericardial fluid allows the collection of a large effusion in days to weeks before a significant increase in pericardial pressure causes symptoms and signs

Question 5

Sintomas clássicos (quando há)

Answer 5

Classic symptoms include dyspnoea on exertion progressing to
orthopnoea, chest pain and/or fullness. Additional occasional symptoms due to local compression may include nausea (diaphragm), dysphagia (oesophagus), hoarseness (recurrent laryngeal nerve) and hiccups (phrenic nerve).

Question 6

Exame físico

Answer 6

Physical examination may be absolutely normal in patients without haemodynamic compromise. When tamponade develops, classic signs include neck vein distension with elevated jugular venous pressure at bedside examination, pulsus paradoxus and diminished heart sounds on cardiac auscultation in cases of moderate to large effusions.82 – 84 Pericardial friction rubs are rarely heard; they can usually be detected in patients with concomitant pericarditis

Question 7

Principal exame para diagnostico e avaliação das dimensões do derrame

Answer 7

Ecocardiografia

Question 8

Que exames complementares devem ser pedidos para pacientes com suspeita de derrame pericárdico?

Answer 8

Eco transtorácico
RX de tórax
Avaliação de marcadores inflamatórios (PCR)
TC ou RM cardíaco should be considered in
suspected cases of loculated pericardial
effusion, pericardial thickening and
masses, as well as associated chest
abnormalities

Question 9

Tamponamento cardíaco por derrame pericárdico SEM marcadores inflam aumenta o risco para qual etiologica?

Answer 9

Neoplásica

Question 10

Quando deve ser considerado drenagem pericárdica?

Answer 10

When a pericardial effusion becomes symptomatic without evidence of inflammation or when empiric anti-inflammatory drugs are not successful

Question 11

TT do derrame deve ser orientado de acordo com etiologia. V/F?

Answer 11

V

Question 12

Quando deve ser considerado pericardiectomia?

Answer 12

should be considered whenever fluid reaccumulates, becomes loculated or biopsy material is required

Question 13

Derrame pericárdico associado a elevação de marcadores inflamatórios. tt?

Answer 13

Tratar como pericardite. Drenagem não é necessária.

Question 14

Indicações para drenagem ou cirurgia cardíaca

Answer 14

Pericardiocentesis or cardiac surgery is
indicated for cardiac tamponade or for
symptomatic moderate to large
pericardial effusions not responsive to
medical therapy, and for suspicion of
unknown bacterial or neoplastic
aetiology

Question 15

Prognóstico de derrame pericárdico Idiopático e de etiologia pericardite

Answer 15

Idiopathic pericardial effusion and pericarditis have an overall good prognosis with a very low risk of complications, especially if the effusion is mild to moderate

Question 16

Prognóstico de derrame pericárdico idiopático de acordo com o volume, correlacionando com tempo para reavaliação com Eco

Answer 16

A mild idiopathic effusion (,10 mm) is usually asymptomatic,
generally has a good prognosis and does not require specific monitoring
Moderate to large effusions (.10 mm) may worsen, and
especially severe effusions may evolve towards cardiac tamponade in up to one-third of cases.
For idiopathic moderate effusions, an
appropriate timing for echocardiographic follow-up may be an
echocardiogram every 6 months. For a severe effusion, an echocardiographic follow-up may be every 3–6 months