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Pericardial Effusion and Tamponade
Pericardial tamponade is caused by elevated pressure in the pericardial space, resulting in equilibration of pericardial, left ventricular, and right ventricular diastolic pressures, which leads to a decrease in preload and cardiac output. An effusion usually is present in pericarditis, but it does not result in tamponade in most cases. The rate at which an effusion develops may determine whether tamponade results. Rapid accumulation of fluid is most likely to develop from penetrating injuries, such as stab or missile wounds, complications of central line insertion, or rupture of myocardium after myocardial infarction. It also may follow retrograde aortic dissection. Tamponade from medical causes of pericarditis is more likely when the underlying cause is a malignancy and when a patient with an existing effusion becomes acutely, severely dehydrated (see also Pericarditis).
Causes
- Pericardial Effusion may be occur due to several infectious such as Viral (coxsackievirus A and B, hepatitis, HIV), Pyogenic (pneumococci, streptococci, staphylococci, Neisseria, Legionella species), Tuberculous, Fungal (histoplasmosis, coccidioidomycosis, Candida), and other infections (syphilitic, protozoal, parasitic).
- Pericarditis may also be caused due to systemic diseases such as autoimmune disorders, rheumatic fever, tuberculosis, cancer, leukemia, kidney failure, HIV infections, AIDS and hypothyroidism.
- Pericardial Effusion can also result from injury including surgery or trauma to the chest, esophagus, or heart.
Symptoms
- Chest pain and tightness
- Shortness of breath
- Peripheral edema
- Dyspnea on exertion
- Altered mental status
Signs
- Tachycardia
- Narrow pulse pressure
- Pulsus paradoxus
- Kussmaul's sign (distention of neck veins with inspiration)
- Pericardial friction rub
- Beck's triad-hypotension, muffled heart sounds, and neck vein distention-is a very late event.
Treatment
- For the treatment of Pericardial Effusion, Antineoplastic therapy such as systemic chemotherapy, radiation is effective. It is used in conjunction with pericardiocentesis has been shown to be effective in reducing recurrences of malignant effusions.
- Another treatment for Pericardial Effusion, In which, it is used to treat the pain with analgesics such as pain killers. The inflammation of the pericardium is treated with anti-inflammatory drugs(NSAIDS) such as aspirin and ibuprofen; in some cases, corticosteroids may be prescribed.
- If the Pericardial Effusion is chronic, recurrent, or results in constrictive pericarditis, it may be advisable to perform pericardiectomy means cutting or removal of part of the pericardium.
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