Pericardial effusions are discussed including the etiology, diagnosis and treatment. Mar 11, 2020 pericardial effusion perekahrdeeul uhfuzhun is the accumulation of too much fluid in the doublelayered, saclike structure around the heart pericardium. Detection of pericardial effusion was the earliest clinical application of echocardiography. Because of the limited amount of space in the pericardial cavity, fluid accumulation leads to an increased intrapericardial pressure which can negatively affect heart function. This electrocardiogram ecg is from a patient with malignant pericardial effusion. Pericarditis usually leads to pericardial effusion, or constrictive pericarditis. In a single case report of a 15yearold girl with pex and pericardial effusion, the anterior posterior compression of the heart was assumed to be the causing mechanism.
We know pericardial disease can cause ecg changes that mimic acs. Diagnostic criteria include the presence of two of the following. The ecg changes associated with pericardial effusion described in textbooks are based only on small series of human cases and data from. Pericarditis pericardial effusion know more about it. Pericardial effusion was classified echocardiographically as small n28, moderate n i3, and large ns. Electrocardiographic changes in pericardial effusion david g. One can also note that the right ventricular free wall is being compressed by the fluid. Despite this, effusion should remain on the differential as this is a potentially fatal complication if it remains unrecognized. If fluid rapidly accumulates in the pericardial space, like in chest trauma, this fluid can compress the heart cardiac tamponade and cause circulatory failure. The ecg shows diffuse low voltage, with a suggestion of electrical alternans in the precordial leads. This work by ecg guru is licensed under a creative commons attributionnoncommercialsharealike 3. Diagnosis and treatment of pericardial effusion uptodate.
Pericardial effusion and tamponade pericardial effusion is an increase in fluid within the pericardium. Moderate or large pericardial effusion echocardiography is useful in a confirming the diagnosis of pericardial effusion b localization of pericardial effusion in cases of localized effusions. Pericarditis ecg changes litfl ecg library diagnosis. With a 12lead electrocardiogram see the image below, the following findings suggest, but are not diagnostic for, pericardial tamponade. The heart is surrounded by fluid black and swings back and forth in the fluid. The ecg variables were independently measured by two in. Pericardial effusions will have an anechoic stripe between the left atrium and descending thoracic aorta. Learn more about both conditions including epidemiology, etiology, pathology, pathophysiology, symptoms, diagnosis, therapy and prognosis. The spectrum of pericardial effusions ranges from mild asymptomatic effusions to cardiac tamponade. Patients with pericardial effusions may quickly progress to cardiac tamponade. Pericardial effusion is fluid in the space between the heart and the pericardial sac. The ecg changes of pericarditis can be confused with those of acute. Pearls and perils of acute pericarditis british columbia.
On other occasions, pericardial effusion is an unexpected finding that requires specific evaluation. Ecg changes caused by pericardial effusion and cardiac tamponade. A pericardial effusion with enough pressure to adversely affect heart function is. Widespread st segment changes occur due to involvement of the. Pericardial effusion perekahrdeeul uhfuzhun is the accumulation of too much fluid in the doublelayered, saclike structure around the heart pericardium. Management of pericardial effusion european heart journal.
Acute pericarditis on the electrocardiogram my ekg english. Cardiac tamponade is a condition that causes impaired cardiac filling due to a high pericardial pressure and increased amount of fluid within sac. While the finding of a pericardial effusion in a patient with known or suspected pericarditis supports the diagnosis, the absence of a pericardial effusion or other. Resulting most frequently from idiopathic cause, intrapericardial pressure is frequently elevated in these patients, which may lead to unexpected tamponade in up to 30% of patients. However, electrical alternans is also associated with other pathologies. Pericardial disease is common, with reports in referral institutions of 8% of cardiac cases in dogs and 6% of feline cases. Mainly, we are limited by the resolution power of echo. Which 12lead ecg findings suggest cardiac tamponade. Which ecg findings are characteristic of pericardial effusion. Cleveland clinic imaging specialists in the center for the diagnosis and treatment of pericardial diseases often use a variety of ways to check for pericarditis and any complications, such as pericardial effusion or constrictive pericarditis. There is no single demographic affected, as there are many underlying causes of pericardial effusion. Typical ecg changes see below new or worsening pericardial effusion. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Pericardial effusion symptoms and causes mayo clinic.
Pericardial effusion is a common finding in clinical practice either as incidental finding or manifestation of a systemic or cardiac disease. Changes in qrs voltage in cardiac tamponade and pericardial. This book is distributed under the terms of the creative commons. Echocardiogram echocardiography is often normal in patients with the clinical syndrome of acute pericarditis unless there is an associated pericardial effusion. Note that pericarditis inflammation of the pericardial sac is difficult to discern from myocarditis inflammation of the myocardial tissue and because they tend to accompany each other, the term perimyocarditis is often used. The space between the layers normally contains a thin layer of fluid. The clinical presentation of pericarditis in children is similar to that of adults with certain caveats.
Md, which provides a convenient and accessible forum to learn the fundamentals and foundations of ecg interpretation. What is the demarcation point between pleural from pericardial surface. Primarily useful to exclude alternative diagnoses which present in a similar manner, including ischemic heart disease, and evaluate for the presence or absence of a pericardial effusion and potential tamponade. Assessing minimal effusions systolic vs diastolic echo free space and associated thickened pericardium is tough even after 50 years of echocardiography. The ecg criteria of cardiac tamponade we adopted was as follows. Echocardiography in evaluation of pericardial disease. Postcardiotomy syndrome tends to occur within 12 weeks of the surgery. The significance of effusions lies in their relationship to an underlying disease state and in their potential to affect a patients haemodynamics.
Massive pericardial effusion produces a triad of low qrs voltage. Pericarditis knowledge for medical students and physicians. In summary, we examined the diagnostic value of 12lead ecg for pericardial effusion and cardiac tamponade. Electrocardiographic changes in pericardial effusion chest journal. Guidelines on the diagnosis and management of pericardial. Ibuprofen 600mg every 8 hours for 7 to 10 days, followed by tapering during a period of 3 to 4 weeks. The auenbrugger sign is discussed in the setting of a large pericardial effusion. Pericardial effusion is a frequent finding that occurs due to primary pericardial disease or in relation to a myriad of systemic disease processes. In dogs, primary acquired disease is most common, where local often. Pericardial effusion is the condition of having an abnormal amount of fluid in the pericardial cavity of the heart. Pericardial effusion is a buildup of fluid in the pericardium. It is specific, but not sensitive, for tamponade and can also be seen in large pericardial effusions. Lowvoltage qrs complexes, classically defined as total. Mar 23, 2020 pericardial effusion can lead to cardiac tamponade which when left undetected or untreated is fatal.
Subcostal view of an echocardiogram that shows a moderate to large amount of pericardial effusion. Ecg findings in massive pericardial effusion litfl ecg. Not all patients go through all stages and manifestations may vary. Advanced ecg interpretation rebecca sevigny bsn, rn, ccrn. Pediatric pericarditis american college of cardiology. Currently, the diagnosis of acute pericarditis is based on demonstrating at least two of the following four criteria. Loculated effusions are common in postsurgical, posttrauma or postpurulent pericarditis.
St and prsegment changes are relative to the baseline formed by the tp segment. Pericardial disease american college of cardiology. Although clinical and ekg findings of both diseases seem different, providing a complete assessment may be difficult in clinical. There are many causes of pericardial effusion, with infection viral and tb as the most common. Guidelines on the diagnosis and management of pericardial diseases full text the task force on the diagnosis and management of pericardial diseases of the european society of cardiology task force members, bernhard maisch, chairperson germany, petar m. Kashou continues to lead and teach weekly ecg sessions and weekend seminars for residents, nurses, ecg interpreting technicians, and physician assistants at the mayo clinic. Detection of a pericardial rub on auscultation and 4. The ecg changes associated with pericardial effusion described in textbooks are based only on small. A pericardial effusion is considered to be present when accumulated fluid within the sac exceeds the small amount that is normally present. Sinus tachycardia lowvoltage qrs complexes electrical. Differentiate pericardial effusion from pleural effusion using the parasternal long axis view. Amal mattus ecg case of the week december 18, 2017 hpi.
Horowitz classification of pericardial effusion dr. The buildup of fluid may affect how the heart works. Practice the premier ekg resource for medical professionals. Massive pericardial effusion produces a triad of low qrs voltage, tachycardia, electrical alternans.
Pericardial effusion ecg guru instructor resources. Standard ecg criteria for low voltage leads i, ii, iii each ecg criteria which improved sensitivity resulted in an unacceptably high prevalence of falsepositive diagnoses of pericardial effusion. But if the pericardium is diseased or injured, the resulting inflammation can lead to excess fluid. If enough fluid accumulates it will restrict cardiac filling and lead to acute heart failure, this is called cardiac tamponade. Acute pericarditis an overview sciencedirect topics. Infants and young children tend to be fussy and have decreased feeding with tachycardia being an important physical sign. Congenital, acquired primary and acquired secondary forms have been described. Diagnostic value of electrocardiogram in cardiac tamponade. Aug, 2010 detection of pericardial effusion was the earliest clinical application of echocardiography.
Tamponade may result from pericardial effusion of any cause. This rhythm is typically associated with pericardial effusion via the swinging heart from the fluid surrounding the heart. Pericardial effusion in acute cases, even a relatively small build up of pericardial fluid can lead to hemodynamic compromise. Nov 28, 2018 pericardial effusion is the presence of an abnormal amount of fluid andor an abnormal character to fluid in the pericardial space. Although no criteria for the diagnosis of acute pericarditis have been established, prior studies 68 have suggested that at least 2 of the following 4 criteria should be present. Acute pericarditis is an inflammation of the pericardium. Diagnostic criteria for acute pericarditis 4 at least two of the following four criteria must be present for a diagnosis of acute pericarditis. Pericardial effusion can lead to cardiac tamponade which when left undetected or untreated is fatal. Pericardial effusion is the presence of an abnormal amount of fluid in the pericardial space.
Clinical presentation of pericardial effusions does not relate so much to the size of the effusion but rather the speed at which the fluid has accumulated, as slow gradual accumulation allows the pericardium to stretch and accommodate much larger volumes of. This rhythm is typically associated with pericardial effusion via the swinging. The sac normally contains a small amount of clear fluid between its layers. Electrical alternans is associated with massive pericardial effusion.
Pdf pericardial effusion and cardiac tamponade in a dog. Assessment of pericardial effusion bmj best practice. His passion for medical education and innovation led to the development of ekg. Electrocardiographic changes in pericardial effusion. Another recent criteria to differentiate acute stemi from acute pericarditis may improve the differential diagnostic yield of the classical ecg criteria. Pericardial effusion and cardiac tamponade knowledge for. This inflammation causes ekg changes that have typically evolved sequentially through 4 stages 1 acute pericarditis can be difficult to distinguish from stsegment elevation myocardial infarction. Sometimes, its cause is obviously related to an underlying general or cardiac disease, or to a syndrome of inflammatory or infectious acute pericarditis.
Sinus tachycardia is also common in acute pericarditis due to pain andor pericardial effusion. Electrocardiography pericarditis, pericardial effusion and cardiac. May 15, 2000 patients were considered to have idiopathic pericardial effusion if they met all of the following criteria. This is third video is about cardiovascular cardiac diseases pericardium pericarditis and pericardial effusion. Pericardial effusion and cardiac tamponade summary pericardial effusion is the acute or chronic accumulation of fluid in the pericardial space between the parietal and the visceral pericardium and is often associated with a variety of underlying disorders. Ecg findings in massive pericardial effusion litfl ecg library. There may be an associated pericardial friction rub or evidence of a pericardial effusion. Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. In other cases, the effusion and its clinical consequences ie, cardiac tamponade and constrictive pericarditis are. The pericardial space cavity always contains a small amount of serous fluid which acts as a lubricant that prevents friction during ventricular contraction and relaxation. Diagnostic value of electrocardiogram in cardiac tamponade med j malaysia vol 74 no 1 february 2019 53. Pericardial effusion and cardiac tamponade symptoms and ecg. Cardiac tamponade and pericardial effusion have long been associated with low voltage of the 12lead electrocardiogram ecg 1, 2, and the diagnostic. This echocardiogram shows a large amount of pericardial effusion identified by the white arrows.
Ecg is abnormal in most cases of tuberculous pericardial effusion, usually in the form of nonspecific sttwave changes. It can be caused by a variety of local and systemic disorders, or it may be idiopathic. Cleveland clinic is a nonprofit academic medical center. Esc guidelines on pericardial diseases diagnosis and. We found that the presence of pr segment depression or low voltage on a 12lead ecg is suggestive, but not diagnostic, of pericardial effusion and cardiac tamponade. Ecg evidence of pr depression or st segment deviation, 3. The most common pericardial diseases result in accumulation of pericardial fluid. Pericardial effusion is a common finding in everyday practice.
Small amounts of pericardial effusion may not cause any ecg changes. The pericardium is a 2layer sac that surrounds the heart. In some cases, the clinical presentation of acute pericardial inflammation predominates, and the presence of excess pericardial fluid is clinically unimportant. Xray is an excellent way to detect the presence of pericardial effusion in the patient. Mar 16, 2019 sinus tachycardia is also common in acute pericarditis due to pain andor pericardial effusion. This my friends, is the extreme case of a pericardial effusion. Pericarditis and pericardial effusion free osmosis videos. Pericardial effusion is considered chronic when moderate to large effusions persist for at least 3 months. Permissions beyond the scope of this license may be available. To investigate the association between ecg changes and the presence of pericardial effusion. Mar 16, 2019 electrical alternans is associated with massive pericardial effusion. This allows the heart to move smoothly against other organs in the chest as it beats. However, the presence of pericardial effusion is difficult with ekg.
Electrical alternans is defined as alternating qrs amplitude that is seen in any or all leads on an electrocardiogram ecg with no additional changes to the conduction pathways of the heart. Cardiac tamponade is when the pressure from a pericardial effusion constricts the heart to a point where it begins to affect cardiac output. These patients were age and sex matched to 46 patients without effusion control subjects. An 81yearold with history of leukemia presents to the ed with dyspnea and pleuritic chest pain. Low electrocardiographic voltage in pericardial effusion. An increase in intrapericardial pressure, resulting in compression of the heart, and thereby a resitriction of cardiac inflow, is termed cardiac tamponade. The pericardial disease clinical topic collection gathers the latest guidelines, news, jacc articles, education, meetings and clinical images pertaining to its cardiovascular topical area all in one place for your convenience. Pericardial effusions can cause cardiac tamponade and be lifethreatening. Free medical books cardiology pericarditis and pericardial effusion free osmosis videos cardiology cardiovascular pericarditis and pericardial effusion free osmosis videos. The presence of microvoltage complexes pericardial effusion. Pericardial effusion, sometimes referred to as fluid around the heart, is the abnormal buildup of excess fluid that develops between the pericardium, the lining of the heart, and the heart itself.