Pericardial effusion: clinical findings and tamponade
THE CONTEXT
Pericardial effusion may alter heart sounds and cause chest discomfort. Large or rapidly developing effusions can compress the heart and cause acute heart failure.
Clinical effects of an effusion
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Heart sounds may become quieter as an effusion develops.
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An existing pericardial friction rub may diminish in intensity but does not always disappear.
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Larger effusions may cause a sensation of retrosternal oppression. Most effusions do not have significant haemodynamic effects.
Cardiac tamponade
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Large or rapidly developing effusions may cause cardiac tamponade: acute heart failure due to compression of the heart.
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Typical findings include markedly raised jugular venous pressure, hypotension, pulsus paradoxus and oliguria.
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Loculated effusions following previous pericarditis or cardiac surgery may cause atypical presentations.
Associated investigation findings
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The illustrated echocardiogram demonstrates a large circumferential pericardial effusion.
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The accompanying viral pericarditis electrocardiogram shows widespread ST elevation. Upward concavity of the ST segments and involvement of both anterior and inferior leads help distinguish pericarditis from acute myocardial infarction.