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Pericardial Effusion


Acknowledgment

The authors would like to acknowledge the contributions of Drs. Terence Wallace and Bruce D. Spiess to this text in the previous edition.

Risk

  • Occurs rarely

  • May be seen after open-heart surgery or PTCA.

  • Blood and/or serous

  • May be caused by infection: Viral, bacterial, or fungal

  • May have a neoplastic etiology: Lymphoma, leukemia

  • Can occur after acute MI, especially transmural

  • Can be due to trauma

  • Gender predominance: More common among men than women

Perioperative Risks

  • If undiagnosed, tamponade leading to CV collapse is possible, with a low probability of determining the cause antemortem.

  • Risk of CV collapse, especially with induction and institution of positive-pressure ventilation.

Worry About

  • Hypovolemia

  • Limited filling of cardiac chambers

Overview

  • Effusion is found in the sac surrounding heart; if severe, it can restrict filling of the heart.

  • Ventricular filling is depressed in both the RV and the LV.

  • Fluid bolus and inotropes are beneficial but do little to improve CO.

  • CO becomes more dependent on heart rate.

  • For proper treatment, surgical drainage must be implemented.

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