Pericardial Effusion

Question 1

What is the typical volume of fluid in the pericardial sac?

Answer 1

Less than 50 mL

Question 2

What are the layers of the myocardial structure from outer to inner?

Answer 2

• Fibrous layer (outer)
• Serous layer (inner)
• Pericardial sac (cavity)
• Serous layer (visceral)
• Epicardium
• Mid wall
• Endocardium

Question 3

What are the roles of the pericardium?

Answer 3

• Stabilizes the heart in the thorax
• Protects the heart from infection
• Acts as a lubricant during heart function

Question 4

What is pericarditis?

Answer 4

Inflammation of the pericardium

Question 5

What is the primary cause of pericarditis?

Answer 5

Idiopathic or viral

Question 6

What results from pericarditis?

Answer 6

Abnormal accumulation of fluid

Question 7

What are the variances of pericardial disease?

Answer 7

• Fibrin deposition
• Hemorrhagic exudate
• Collagen deposition

Question 8

What is Dressler syndrome?

Answer 8

Secondary form of pericarditis occurring after injury to the heart or pericardium

Question 9

What are the symptoms of Dressler syndrome?

Answer 9

• Fever
• Chest pain
• Pericarditis/pericardial fusion

Question 10

What is cardiac tamponade?

Answer 10

Increased pericardial pressure due to accumulation of fluid

Question 11

What should be the pressure within the pericardial space?

Answer 11

0 mmHg

Question 12

What occurs when pericardial pressure exceeds cardiac pressure?

Answer 12

Impaired diastolic filling and reduction in stroke volume

Question 13

What are the clinical signs/symptoms of pericardial effusion?

Answer 13

• Dyspnea that improves when leaning forward
• Chest pain
• Near syncope
• Tachycardia

Question 14

What is Beck’s triad?

Answer 14

• Hypotension due to lack of filling
• Muffled heart sounds
• Increased venous pressure due to increased resistance

Question 15

What is pulses paradoxus?

Answer 15

A hallmark finding in cardiac tamponade where blood pressure decreases during inhalation

Question 16

What confirms the presence of pulses paradoxus?

Answer 16

Dropping in systolic blood pressure greater than 10 mmHg upon inspiration

Question 17

What are the characteristics of hypotension due to lack of filling?

Answer 17

• Narrow pulse pressure (e.g., 100/80)
• Tachycardia

Question 18

What size is classified as trivial pericardial effusion?

Answer 18

Less than 5 mm

This classification helps in assessing the clinical significance of the effusion.

Question 19

What size range is considered small pericardial effusion?

Answer 19

Greater than 5 mm but less than 10 mm

Understanding the size of the effusion is critical for management decisions.

Question 20

What size range is classified as moderate pericardial effusion?

Answer 20

Greater than 10 mm but less than 20 mm

This classification is important for evaluating the risk of tamponade.

Question 21

What size is considered large pericardial effusion?

Answer 21

Greater than 20 mm

Large effusions are more likely to cause clinical symptoms and complications.

Question 22

When should pericardial effusion be measured?

Answer 22

At end diastole

Measuring at this time provides the most accurate assessment of the effusion’s impact.

Question 23

What are the characteristics of low pressure/small effusion tamponade?

Answer 23

Normal blood pressure, borderline, tacky, right ventricular diastolic collapse

This condition may still present with significant clinical signs despite normal pressures.

Question 24

What echo findings indicate tamponade?

Answer 24

Echo free space especially during diastole, right ventricular diastolic collapse

These findings are crucial for the diagnosis of cardiac tamponade.

Question 25

What does respiratory variation in Doppler findings indicate?

Answer 25

May indicate tamponade ## Footnote Changes in E wave during respiration are significant in assessing hemodynamic status.

Question 26

What are the characteristics of a small chronic pericardial effusion?

Answer 26

Normal heart rate, no right ventricular collapse, normal blood pressure ## Footnote This presentation may require monitoring rather than immediate intervention.

Question 27

What is the clinical presentation of moderate pericardial effusion with tamponade?

Answer 27

Hypotensive, tachycardic, right ventricular diastolic collapse ## Footnote This combination of signs indicates a need for urgent intervention.

Question 28

What are the key features of pericardial effusion with tamponade?

Answer 28

Hypotensive, right ventricular diastolic collapse, circumferential pericardial effusion, causing a swinging heart ## Footnote These clinical signs are critical for diagnosing and managing tamponade.

Question 29

What E wave changes indicate potential tamponade on the mitral valve?

Answer 29

E wave increases greater than 40% during expiration ## Footnote This measurement helps assess diastolic function and potential hemodynamic compromise.

Question 30

What E wave changes indicate potential tamponade on the tricuspid valve?

Answer 30

E wave increases greater than 25% upon inspiration ## Footnote This finding is important for evaluating right heart function.

Question 31

What should be measured to assess the E wave changes?

Answer 31

E wave of changes on mitral valve, use MO on subcostal to evaluate right ventricular diastolic collapse ## Footnote These measurements provide insights into the fluid dynamics and cardiac function.

Question 32

What should be assessed during the sonographers approach to pericardial effusion?

Answer 32

Assess pericardial space in all views, measure fluid in all spaces, assess all chambers for collapse, use pulse wave on tricuspid and mitral valve ## Footnote A comprehensive assessment is essential for accurate diagnosis and management.

Question 33

What does IVC collapse ability indicate?

Answer 33

Right atrial pressure ## Footnote Assessing IVC collapse is crucial for estimating volume status and cardiac filling pressures.

Question 34

What does hepatic vein diastolic flow reversal indicate?

Answer 34

Diastolic flow reversal during expiration ## Footnote This finding may suggest elevated right atrial pressures or tamponade physiology.