Materiały źródłowe

• #1 Assessment of pericardial effusion – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/458

  Pericardial effusion is present when the fluid in the pericardial space exceeds its physiological amount (50 mL). In the clinical setting, pericardial effusion is relatively common. It may be detected incidentally on a cardiac or chest imaging study, or manifest on the background of a cardiac or systemic disease. […] The significance of effusions lies in their relationship to an underlying disease state and in their potential to affect a patient’s haemodynamics. […] The development of a pericardial effusion often has important implications for the diagnosis and/or prognosis of the underlying disease.

• #2 Evaluation of pericardial effusion – Differential diagnosis of symptoms | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/458

  Pericardial effusion is present when the fluid in the pericardial space exceeds its physiologic amount (50 mL). In the clinical setting, pericardial effusion is relatively common. It may be detected incidentally on a cardiac or chest imaging study, or manifest on the background of a cardiac or systemic disease. […] The significance of effusions lies in their relationship to an underlying disease state and in their potential to affect a patient’s hemodynamics. […] The development of a pericardial effusion often has important implications for the diagnosis and/or prognosis of the underlying disease.

• #3 Pericardial effusion – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pericardial-effusion/diagnosis-treatment/drc-20353724

  To diagnose pericardial effusion, the health care provider will typically perform a physical exam and ask questions about your symptoms and medical history. He or she will likely listen to your heart with a stethoscope. If your health care provider thinks you have pericardial effusion, tests can help identify a cause. […] Tests to diagnose or confirm pericardial effusion may include: […] Echocardiogram. Sound waves are used to create pictures of the heart in motion. An echocardiogram shows the heart chambers and how well the heart is pumping blood. The test can help determine the amount of fluid between the two layers of the pericardium. An echocardiogram may also show decreased heart function due to pressure on the heart (tamponade). […] Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. Your cardiologist or another health care provider can look for signal patterns that suggest cardiac tamponade.

• #4 Pericardial Effusion | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pericardial-effusion.html

  How is pericardial effusion diagnosed? […] The process starts with a health history and a physical exam. Your healthcare provider will ask about your symptoms and past medical conditions. For symptoms of shock, it’s important to find the cause quickly. […] Tests may also be done, such as: […] Chest X-ray to see the heart anatomy […] Imaging of the chest or heart with a CT scan or MRI […] Echocardiogram (echo) to look at fluid around the heart and heart motion […] Electrocardiogram (ECG) to analyze the hearts electrical rhythm […] If a pericardial effusion is found, healthcare providers must try to diagnose the cause. They may use tests such as: […] Analysis of the fluid removed from around the heart to check for cancer or infection […] Different blood tests to diagnose infection, immune system problems, or metabolic problems.

• #5 Pericardial effusion – Wikipedia

  https://en.wikipedia.org/wiki/Pericardial_effusion

  A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. […] Echocardiogram, CT and MRI are the most common methods of diagnosis, although chest X-ray and EKG are also often performed. […] Patients with pericardial effusion may have unremarkable physical exams but often present with tachycardia, distant heart sounds and tachypnea. […] A physical finding specific to pericardial effusion is dullness to percussion, bronchial breath sounds and egophony over the inferior angle of the left scapula. […] Patients with concern for cardiac tamponade may present with abnormal vitals and what’s classically known as the Beck’s triad, which consists of hypotension (low blood pressure), jugular venous distension and distant heart sounds. […] Patients presenting with cardiac tamponade may also be evaluated for pulsus paradoxus.

• #6 Pericardial Effusion: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/157325-overview

  Pericardial effusion is the presence of an abnormal amount of fluid and/or an abnormal character to fluid in the pericardial space. […] Examination findings in patients with pericardial effusion include the following: Classic Beck triad of pericardial tamponade: Hypotension, muffled heart sounds, jugular venous distention. […] The following laboratory studies may be performed in patients with suspected pericardial effusion: Electrolyte levels, CBC count with differential, Cardiac biomarker levels (eg, troponin, CK-MB, LDH), Tests for other markers of inflammation (eg, ESR, CRP), TSH level, Blood cultures, RF levels, Immunoglobulin complex tests, ANA tests, Complement levels, Pericardial fluid analysis. […] Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion and includes the following techniques: 2-D echocardiography, M-mode echocardiography: Adjunct to 2-D echocardiography, Doppler echocardiography, Transesophageal echocardiography, Intracardiac echocardiography. […] Procedures that may be used in patients with pericardial effusion include the following: Diagnostic and/or therapeutic pericardiocentesis, Diagnostic pericardioscopy, Placement of a pulmonary artery catheter.

• #7 Diagnosis, treatment, and management of pericardial effusion- review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9283797/

  Numerous imaging techniques are utilized to evaluate pericardial effusion including chest X-ray, electrocardiogram, transthoracic echocardiography, computed tomography scan, cardiac magnetic resonance imaging, and pericardiocentesis. […] In patients with a differential diagnosis of pericardial effusion, the echocardiogram is the most widely available and reliable technique to authenticate the presence and severity of pericardial effusion. […] For decades, transthoracic echocardiography is the diagnostic modality of choice for the definitive evaluation of pericardial effusion (Class I recommendation, LOE C according to 2015 ESC guidelines). […] Although echocardiography is the diagnostic imaging modality of choice for the assessment of pericardial effusion, a CT scan can be utilized when more accurate details about the location, extent, and quantity of pericardial fluid are required, or when the effusion is complex or has clots.

• #8 Diagnosis, treatment, and management of pericardial effusion- review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9283797/

  Pericardiocentesis is not essential for the diagnosis of the underlying cause of pericardial effusion. […] B-TTE allows the effective and timely identification of cardiac abnormalities in emergency situations such as thickened left-ventricular wall, small pericardial effusion, dysfunction of the valvular structures, and cardiac chamber dilations. […] The prognosis of pericardial effusion is determined by the underlying etiology. […] Echocardiography remains the imaging modality of choice for the diagnosis of pericardial effusion.

• #9 Diagnosis and management of pericardial effusion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3110902/

  Pericardial effusion is a common finding in everyday clinical practice. The first challenge to the clinician is to try to establish an etiologic diagnosis. Sometimes, the pericardial effusion can be easily related to a known underlying disease, such as acute myocardial infarction, cardiac surgery, end-stage renal disease or widespread metastatic neoplasm. […] The presence of acute inflammatory signs (chest pain, fever, pericardial friction rub) is predictive for acute idiopathic pericarditis irrespective of the size of the effusion or the presence or absence of tamponade. Severe effusion with absence of inflammatory signs and absence of tamponade is predictive for chronic idiopathic pericardial effusion, and tamponade without inflammatory signs for neoplastic pericardial effusion. […] The echocardiogram is the most available and reliable technique in order to verify the presence and the amount of a pericardial effusion; in addition, the echocardiogram offers valuable data for evaluation of hemodynamic repercussion.

• #10 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] The following lab studies may be performed in patients with suspected pericardial effusion: Electrolytes – To assess for metabolic abnormalities (eg, renal failure). […] It should be noted that routine biochemical and cell-count analysis has a low yield in diagnosing the cause of effusion. In contrast, Gram stain and culture can ascertain the etiology convincingly. […] Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] Patients with viral cardiomyopathy, especially in the acute setting, may have a similar presentation to patients with pericardial effusion, with an enlarged heart being seen on chest radiographs. Echocardiography readily distinguishes the difference between enlarged cardiac chambers and a pericardial effusion.

• #11 Diagnosis of acute pericarditis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis

  Supportive findings are elevation of inflammatory markers and evidence of pericardial inflammation by computed tomography (CT) or cardiac magnetic resonance (CMR). […] Pericardial effusion, either new appearing or worsening, is typically mild and is evident in 60% of cases. […] Pericardial effusion, based on the size at diastole, is characterised as mild (10 mm), moderate (10-20 mm), or large (20 mm). […] Multimodality imaging is an integral part of an acute pericarditis diagnostic workup and, apart from echocardiography which is considered the first-line test, includes CT and/or CMR (second-line imaging tests). […] The emerging role of new inflammatory markers (i.e. CEACAM1 and MICA) is hopeful.

• #12 Pericardial effusion – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pericardial-effusion/diagnosis-treatment/drc-20353724

  To diagnose pericardial effusion, the health care provider will typically perform a physical exam and ask questions about your symptoms and medical history. He or she will likely listen to your heart with a stethoscope. If your health care provider thinks you have pericardial effusion, tests can help identify a cause. […] Tests to diagnose or confirm pericardial effusion may include: […] Echocardiogram. Sound waves are used to create pictures of the heart in motion. An echocardiogram shows the heart chambers and how well the heart is pumping blood. The test can help determine the amount of fluid between the two layers of the pericardium. An echocardiogram may also show decreased heart function due to pressure on the heart (tamponade). […] Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. Your cardiologist or another health care provider can look for signal patterns that suggest cardiac tamponade.

• #13 The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-021-00205-x

  Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). […] The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. […] The average time-to-diagnosis with POCUS was 5.9 h compared to 12 h with other imaging including departmental ECHO. […] POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention. […] Echocardiography (ECHO) remains as the gold standard imaging modality to verify the presence of a PCE by demonstrating fluid collection in the pericardial space and interrogating for features of tamponade physiology such as systolic right atrial (RA) collapse, early diastolic right ventricle (RV) collapse, respiratory variations of transvalvular flow.

• #14 Diagnosis and Management of Pericardial Effusion

  https://www.mdpi.com/2392-7674/7/2/23

  Pericardial effusion is a common pathology in clinical practice. […] Transthoracic echocardiography is the gold standard investigation for the diagnosis of pericardial effusions. […] The echocardiographic signs of cardiac tamponade are represented by the collapse of the right atrium and right ventricle, respiratory alteration of mitral and tricuspid flow, and changes of the inferior vena cava. […] This is a review of the diagnosis and treatment of pericardial effusion. […] The European Society of Cardiology guideline for pericardial diseases requires two out of the following four criteria for the diagnosis of acute pericarditis: pericardial chest pain, pericardial rub, ST-segment elevation on ECG and pericardial effusion. […] Transthoracic echocardiography is the most useful investigation for the diagnosis of pericardial effusion. […] Pericardiocentesis guided by echocardiography is a lifesaving procedure in cases of large pericardial effusions and cardiac tamponade.

• #15 The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-021-00205-x

  Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). […] The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. […] The average time-to-diagnosis with POCUS was 5.9 h compared to 12 h with other imaging including departmental ECHO. […] POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention. […] Echocardiography (ECHO) remains as the gold standard imaging modality to verify the presence of a PCE by demonstrating fluid collection in the pericardial space and interrogating for features of tamponade physiology such as systolic right atrial (RA) collapse, early diastolic right ventricle (RV) collapse, respiratory variations of transvalvular flow.

• #16 The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-021-00205-x

  Given the insidious nature of PCE, evaluation with POCUS could reduce the time-to-diagnosis which had truncated by 39 h in our study. […] In terms of time-to-pericardiocentesis, our data demonstrated the POCUS group received the intervention 21 h earlier than the departmental ECHO group. […] Clinically significant PCE presents with non-specific findings whereby a high degree of clinical suspicion is necessitated. However, POCUS is a readily available bedside diagnostic tool that can quickly rule in the diagnosis.

• #17

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m3-curriculum/bedside-ultrasonagraphy/pericardial-effusion

  Focused cardiac ultrasound is the diagnostic study of choice for identifying pericardial effusions. […] Ultrasound is a readily accessible bedside tool that can quickly and accurately diagnose pericardial effusions and cardiac tamponade. […] Overall, studies have demonstrated excellent sensitivities and specificities from 96-100% for the detection of pericardial effusions in both medical and trauma patients using focused cardiac ultrasound. […] Point-of-care ultrasound visualized a large, circumferential pericardial effusion. […] An emergent pericardiocentesis was performed, after which the blood pressure improved to 110/60.

• #18 Pericardial effusion – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pericardial-effusion/diagnosis-treatment/drc-20353724

  Chest X-ray. An X-ray image of the chest allows a health care provider to check the size and shape of the heart. A chest X-ray can show signs of an enlarged heart if the effusion is large. […] computed tomography (CT) and Magnetic resonance imaging (MRI) scans can detect pericardial effusion, although they’re generally not used to look for the condition. However, pericardial effusion may be diagnosed when these tests are done for other reasons.

• #19 Pericardial Effusion | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pericardial-effusion.html

  How is pericardial effusion diagnosed? […] The process starts with a health history and a physical exam. Your healthcare provider will ask about your symptoms and past medical conditions. For symptoms of shock, it’s important to find the cause quickly. […] Tests may also be done, such as: […] Chest X-ray to see the heart anatomy […] Imaging of the chest or heart with a CT scan or MRI […] Echocardiogram (echo) to look at fluid around the heart and heart motion […] Electrocardiogram (ECG) to analyze the hearts electrical rhythm […] If a pericardial effusion is found, healthcare providers must try to diagnose the cause. They may use tests such as: […] Analysis of the fluid removed from around the heart to check for cancer or infection […] Different blood tests to diagnose infection, immune system problems, or metabolic problems.

• #20 Chest X-ray – Cardiac disease – Pericardial effusion

  https://www.radiologymasterclass.co.uk/gallery/chest/cardiac_disease/pericardial_effusion

  This image shows some of the features of heart failure. […] The heart is also enlarged and has a globular (rounded) appearance due to a pericardial effusion (fluid accumulation within the pericardial sac). […] Whenever the heart appears globular, it could be due to a pericardial effusion the diagnosis can be confirmed using ultrasound (echocardiogram). […] This patient with metastatic disease (primary colon cancer) has an enlarged and globular-shaped heart due to a malignant pericardial effusion (fluid and cancerous cells within the pericardium).

• #21 Diagnosis, treatment, and management of pericardial effusion- review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9283797/

  Numerous imaging techniques are utilized to evaluate pericardial effusion including chest X-ray, electrocardiogram, transthoracic echocardiography, computed tomography scan, cardiac magnetic resonance imaging, and pericardiocentesis. […] In patients with a differential diagnosis of pericardial effusion, the echocardiogram is the most widely available and reliable technique to authenticate the presence and severity of pericardial effusion. […] For decades, transthoracic echocardiography is the diagnostic modality of choice for the definitive evaluation of pericardial effusion (Class I recommendation, LOE C according to 2015 ESC guidelines). […] Although echocardiography is the diagnostic imaging modality of choice for the assessment of pericardial effusion, a CT scan can be utilized when more accurate details about the location, extent, and quantity of pericardial fluid are required, or when the effusion is complex or has clots.

• #22 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Pericardial effusion appears as an echo-free space between the visceral and parietal pericardium. […] Echocardiography may identify features that suggest hemodynamically significant cardiac tamponade; however, this is a clinical (not echocardiographic) diagnosis. […] CT scanning can potentially determine the composition of fluid and may detect as little as 50mL of fluid. […] MRI can detect as little as 30 mL of pericardial fluid. […] Early in the course of acute pericarditis, the ECG typically displays diffuse ST elevation in association with PR depression. […] This procedure is used for diagnostic as well as therapeutic purposes. Support for the use of echocardiographic guidance is increasing, unless emergent treatment is required. Indications for pericardiocentesis include impending hemodynamic compromise (ie, pericardial tamponade), suspected infectious or neoplastic etiology, and uncertain etiology. […] This procedure is not universally available. It may increase diagnostic sensitivity in cases of unexplained pericardial effusions, especially for neoplastic disease.

• #23 Diagnosis of acute pericarditis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis

  Supportive findings are elevation of inflammatory markers and evidence of pericardial inflammation by computed tomography (CT) or cardiac magnetic resonance (CMR). […] Pericardial effusion, either new appearing or worsening, is typically mild and is evident in 60% of cases. […] Pericardial effusion, based on the size at diastole, is characterised as mild (10 mm), moderate (10-20 mm), or large (20 mm). […] Multimodality imaging is an integral part of an acute pericarditis diagnostic workup and, apart from echocardiography which is considered the first-line test, includes CT and/or CMR (second-line imaging tests). […] The emerging role of new inflammatory markers (i.e. CEACAM1 and MICA) is hopeful.

• #24 Pericardial effusion – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pericardial-effusion/diagnosis-treatment/drc-20353724

  To diagnose pericardial effusion, the health care provider will typically perform a physical exam and ask questions about your symptoms and medical history. He or she will likely listen to your heart with a stethoscope. If your health care provider thinks you have pericardial effusion, tests can help identify a cause. […] Tests to diagnose or confirm pericardial effusion may include: […] Echocardiogram. Sound waves are used to create pictures of the heart in motion. An echocardiogram shows the heart chambers and how well the heart is pumping blood. The test can help determine the amount of fluid between the two layers of the pericardium. An echocardiogram may also show decreased heart function due to pressure on the heart (tamponade). […] Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results. Your cardiologist or another health care provider can look for signal patterns that suggest cardiac tamponade.

• #25 Pericardial Effusion | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/pericardial-effusion.html

  How is pericardial effusion diagnosed? […] The process starts with a health history and a physical exam. Your healthcare provider will ask about your symptoms and past medical conditions. For symptoms of shock, it’s important to find the cause quickly. […] Tests may also be done, such as: […] Chest X-ray to see the heart anatomy […] Imaging of the chest or heart with a CT scan or MRI […] Echocardiogram (echo) to look at fluid around the heart and heart motion […] Electrocardiogram (ECG) to analyze the hearts electrical rhythm […] If a pericardial effusion is found, healthcare providers must try to diagnose the cause. They may use tests such as: […] Analysis of the fluid removed from around the heart to check for cancer or infection […] Different blood tests to diagnose infection, immune system problems, or metabolic problems.

• #26 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  The extent to which pericardial effusions should be evaluated with fluid analysis remains an area of some debate. Initially, in a patient with a new pericardial effusion, the likelihood of myocarditis or pericarditis should be assessed, and the initial diagnostic evaluation should be directed toward these conditions. […] In general, all patients with pericardial tamponade, suspected purulent effusion, or poor prognostic indicators in the setting of pericarditis should undergo diagnostic pericardiocentesis. Those with recurrent effusions or large effusions that do not resolve with treatment of the underlying condition may also warrant fluid analysis. […] Electrocardiographic (ECG) changes are part of the criteria for diagnosing acute pericarditis, and therefore an ECG should be performed at the outset of the evaluation.

• #27 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Pericardial effusion appears as an echo-free space between the visceral and parietal pericardium. […] Echocardiography may identify features that suggest hemodynamically significant cardiac tamponade; however, this is a clinical (not echocardiographic) diagnosis. […] CT scanning can potentially determine the composition of fluid and may detect as little as 50mL of fluid. […] MRI can detect as little as 30 mL of pericardial fluid. […] Early in the course of acute pericarditis, the ECG typically displays diffuse ST elevation in association with PR depression. […] This procedure is used for diagnostic as well as therapeutic purposes. Support for the use of echocardiographic guidance is increasing, unless emergent treatment is required. Indications for pericardiocentesis include impending hemodynamic compromise (ie, pericardial tamponade), suspected infectious or neoplastic etiology, and uncertain etiology. […] This procedure is not universally available. It may increase diagnostic sensitivity in cases of unexplained pericardial effusions, especially for neoplastic disease.

• #28 ECG Findings in Massive Pericardial Effusion • LITFL • ECG Library

  https://litfl.com/ecg-findings-in-massive-pericardial-effusion/

  Patients with this ECG pattern need to be immediately assessed for clinical and echocardiographic evidence of tamponade. […] Massive pericardial effusion produces a characteristic ECG triad of: Low QRS voltage, Tachycardia, Electrical alternans. […] Electrical alternans: Alternating QRS complex height best seen in lateral precordial leads.

• #29 Pericardial Effusion: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17351-pericardial-effusion

  Pericardial effusion is a collection of excess fluid in your pericardium, the sac around your heart. […] Treatment depends on how severe your condition is and what caused it. […] If a healthcare provider suspects a pericardial effusion, they may order several different kinds of tests. […] A provider may order an electrocardiogram (EKG) to check your hearts electrical activity. […] After a provider diagnoses pericardial effusion, they may order lab tests to find the cause of your condition. […] The pericardial effusion treatment you get depends on how severe your condition is and what caused it. […] If you have an effusion thats growing more quickly, thats causing symptoms or thats happening because of more serious conditions (especially trauma or cancer), youll probably need treatment sooner rather than later.

• #30 Pericardial Effusion: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/157325-overview

  Pericardial effusion is the presence of an abnormal amount of fluid and/or an abnormal character to fluid in the pericardial space. […] Examination findings in patients with pericardial effusion include the following: Classic Beck triad of pericardial tamponade: Hypotension, muffled heart sounds, jugular venous distention. […] The following laboratory studies may be performed in patients with suspected pericardial effusion: Electrolyte levels, CBC count with differential, Cardiac biomarker levels (eg, troponin, CK-MB, LDH), Tests for other markers of inflammation (eg, ESR, CRP), TSH level, Blood cultures, RF levels, Immunoglobulin complex tests, ANA tests, Complement levels, Pericardial fluid analysis. […] Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion and includes the following techniques: 2-D echocardiography, M-mode echocardiography: Adjunct to 2-D echocardiography, Doppler echocardiography, Transesophageal echocardiography, Intracardiac echocardiography. […] Procedures that may be used in patients with pericardial effusion include the following: Diagnostic and/or therapeutic pericardiocentesis, Diagnostic pericardioscopy, Placement of a pulmonary artery catheter.

• #31 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] The following lab studies may be performed in patients with suspected pericardial effusion: Electrolytes – To assess for metabolic abnormalities (eg, renal failure). […] It should be noted that routine biochemical and cell-count analysis has a low yield in diagnosing the cause of effusion. In contrast, Gram stain and culture can ascertain the etiology convincingly. […] Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] Patients with viral cardiomyopathy, especially in the acute setting, may have a similar presentation to patients with pericardial effusion, with an enlarged heart being seen on chest radiographs. Echocardiography readily distinguishes the difference between enlarged cardiac chambers and a pericardial effusion.

• #32 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] The following lab studies may be performed in patients with suspected pericardial effusion: Electrolytes – To assess for metabolic abnormalities (eg, renal failure). […] It should be noted that routine biochemical and cell-count analysis has a low yield in diagnosing the cause of effusion. In contrast, Gram stain and culture can ascertain the etiology convincingly. […] Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] Patients with viral cardiomyopathy, especially in the acute setting, may have a similar presentation to patients with pericardial effusion, with an enlarged heart being seen on chest radiographs. Echocardiography readily distinguishes the difference between enlarged cardiac chambers and a pericardial effusion.

• #33 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Pericardial effusion appears as an echo-free space between the visceral and parietal pericardium. […] Echocardiography may identify features that suggest hemodynamically significant cardiac tamponade; however, this is a clinical (not echocardiographic) diagnosis. […] CT scanning can potentially determine the composition of fluid and may detect as little as 50mL of fluid. […] MRI can detect as little as 30 mL of pericardial fluid. […] Early in the course of acute pericarditis, the ECG typically displays diffuse ST elevation in association with PR depression. […] This procedure is used for diagnostic as well as therapeutic purposes. Support for the use of echocardiographic guidance is increasing, unless emergent treatment is required. Indications for pericardiocentesis include impending hemodynamic compromise (ie, pericardial tamponade), suspected infectious or neoplastic etiology, and uncertain etiology. […] This procedure is not universally available. It may increase diagnostic sensitivity in cases of unexplained pericardial effusions, especially for neoplastic disease.

• #34 Pericardial Effusion: Causes, Symptoms, Diagnosis & Treatment

  https://www.webmd.com/heart-disease/pericardial-effusion

  To diagnose pericardial effusion, your doctor will likely ask questions about your medical history and do a physical examination. […] Some tests that may help your doctor diagnose a pericardial effusion include: […] An ultrasound of your heart (echocardiogram), which can show the size of the effusion and if there’s any evidence of cardiac tamponade. This is the best test to confirm a pericardial effusion. […] Once your doctor has identified the effusion, they may do other tests to figure out what caused it. These tests may include: […] Pericardiocentesis (needle aspiration), where your doctor inserts a needle through your chest and takes some fluid to test. This may help your doctor find an infection in the fluid of your pericardium.

• #35 Pericardial effusion – Wikipedia

  https://en.wikipedia.org/wiki/Pericardial_effusion

  Some patients with pericardial effusions may present with no symptoms and the diagnosis can be an incidental finding due to imaging of other illnesses. […] Initial tests include electrocardiography (ECG) and chest x-ray. […] Echocardiography usually confirms the diagnosis and allows assessment of the size, location and signs of hemodynamic instability. […] A transthoracic echocardiogram (TTE) is usually sufficient to evaluate pericardial effusion and it may also help distinguish pericardial effusion from pleural effusion and MI. […] Cardiac CT and MRI scans can help localize and quantify the effusion, especially in a loculated effusion. […] Pericardiocentesis is a procedure in which fluid is aspirated from the pericardial cavity with a needle and catheter. […] Fluid analysis may result in: transudative effusion: due to non-inflammatory causes, exudative effusion: inflammatory or malignant causes, hemorrhagic effusion: high blood concentration.

• #36 Pericardial effusion – Wikipedia

  https://en.wikipedia.org/wiki/Pericardial_effusion

  Some patients with pericardial effusions may present with no symptoms and the diagnosis can be an incidental finding due to imaging of other illnesses. […] Initial tests include electrocardiography (ECG) and chest x-ray. […] Echocardiography usually confirms the diagnosis and allows assessment of the size, location and signs of hemodynamic instability. […] A transthoracic echocardiogram (TTE) is usually sufficient to evaluate pericardial effusion and it may also help distinguish pericardial effusion from pleural effusion and MI. […] Cardiac CT and MRI scans can help localize and quantify the effusion, especially in a loculated effusion. […] Pericardiocentesis is a procedure in which fluid is aspirated from the pericardial cavity with a needle and catheter. […] Fluid analysis may result in: transudative effusion: due to non-inflammatory causes, exudative effusion: inflammatory or malignant causes, hemorrhagic effusion: high blood concentration.

• #37 11. Pericardial Effusion and Cardiac Tamponade | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/11-pericardial-effusion-and-cardiac-tamponade/11-pericardial-effusion-and-cardiac-tamponade

  Pericardial effusions without tamponade can usually be managed conservatively. Consider pericardiocentesis for purulent effusions or if suspicion of infection/malignancy exists; diagnostic yield is quite low, however. […] If tapped, send fluid for: glucose, protein, LDH, cell-count/differential, gram stain/culture, AFB, cytology. Can send ADA levels if suspect TB. Bloody fluid usually suggests TB or tumor though also seen in rheumatic fever, trauma, and uremic pericarditis. […] Pericardial window by CT surgery should be entertained (hole cut in pericardial sac to allow pericardial fluid to be drained into the pleural space) in cases where fluid is expected to continue to accumulate despite initial removal (e.g. malignancy where treatment is unlikely to quickly decrease pericardial fluid accumulation).

• #38 11. Pericardial Effusion and Cardiac Tamponade | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/11-pericardial-effusion-and-cardiac-tamponade/11-pericardial-effusion-and-cardiac-tamponade

  Pericardial effusions without tamponade can usually be managed conservatively. Consider pericardiocentesis for purulent effusions or if suspicion of infection/malignancy exists; diagnostic yield is quite low, however. […] If tapped, send fluid for: glucose, protein, LDH, cell-count/differential, gram stain/culture, AFB, cytology. Can send ADA levels if suspect TB. Bloody fluid usually suggests TB or tumor though also seen in rheumatic fever, trauma, and uremic pericarditis. […] Pericardial window by CT surgery should be entertained (hole cut in pericardial sac to allow pericardial fluid to be drained into the pleural space) in cases where fluid is expected to continue to accumulate despite initial removal (e.g. malignancy where treatment is unlikely to quickly decrease pericardial fluid accumulation).

• #39 Pericardial Fluid Analysis – Testing.com

  https://www.testing.com/tests/pericardial-fluid-analysis/

  To help diagnose the cause of inflammation of the membrane surrounding the heart (pericardium) and/or fluid accumulation around the heart. […] When a health care practitioner suspects that you have a condition associated with inflammation of the pericardium and/or fluid accumulation around your heart. […] Pericardial fluid analysis is a group of tests that evaluate this liquid to help diagnose the cause of the increased fluid. […] Pericardial fluid analysis is used to help diagnose the cause of inflammation of the pericardium (pericarditis) and/or fluid accumulation around the heart (pericardial effusion). […] Pericardial fluid analysis may be ordered when a healthcare practitioner suspects that a person has a condition or disease that is causing pericarditis and/or pericardial effusion. […] Test results can help distinguish between types of pericardial fluid and help diagnose the cause of fluid accumulation. […] The initial set of tests performed on a sample of pericardial fluid helps determine whether the fluid is a transudate or exudate.

• #40 The Importance of Early Diagnosis and Treatment for Pericardial Effusion and Cardiac Tamponade – International Journal of Cardiovascular Sciences

  https://ijcscardiol.org/article/the-importance-of-early-diagnosis-and-treatment-for-pericardial-effusion-and-cardiac-tamponade/

  Pericardial effusion has several etiologies, such as primary pericardial diseases, cardiac surgery, trauma and systemic conditions, including hypothyroidism, renal failure, chronic neoplastic infiltration, autoimmune inflammation, systemic lupus erythematosus, and rheumatoid arthritis. […] In Queiroz et al., pericardial effusion was diagnosed by echocardiography, a widely available and inexpensive method that can be performed at bedside. […] However, the gold standard diagnostic exam is pericardial biopsy, which is indicated for diagnostic investigation in patients with persistent pericarditis refractory to clinical treatment and no definitive diagnosis.

• #41 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Pericardial effusion appears as an echo-free space between the visceral and parietal pericardium. […] Echocardiography may identify features that suggest hemodynamically significant cardiac tamponade; however, this is a clinical (not echocardiographic) diagnosis. […] CT scanning can potentially determine the composition of fluid and may detect as little as 50mL of fluid. […] MRI can detect as little as 30 mL of pericardial fluid. […] Early in the course of acute pericarditis, the ECG typically displays diffuse ST elevation in association with PR depression. […] This procedure is used for diagnostic as well as therapeutic purposes. Support for the use of echocardiographic guidance is increasing, unless emergent treatment is required. Indications for pericardiocentesis include impending hemodynamic compromise (ie, pericardial tamponade), suspected infectious or neoplastic etiology, and uncertain etiology. […] This procedure is not universally available. It may increase diagnostic sensitivity in cases of unexplained pericardial effusions, especially for neoplastic disease.

• #42 Pericardial Effusion: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/157325-overview

  Pericardial effusion is the presence of an abnormal amount of fluid and/or an abnormal character to fluid in the pericardial space. […] Examination findings in patients with pericardial effusion include the following: Classic Beck triad of pericardial tamponade: Hypotension, muffled heart sounds, jugular venous distention. […] The following laboratory studies may be performed in patients with suspected pericardial effusion: Electrolyte levels, CBC count with differential, Cardiac biomarker levels (eg, troponin, CK-MB, LDH), Tests for other markers of inflammation (eg, ESR, CRP), TSH level, Blood cultures, RF levels, Immunoglobulin complex tests, ANA tests, Complement levels, Pericardial fluid analysis. […] Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion and includes the following techniques: 2-D echocardiography, M-mode echocardiography: Adjunct to 2-D echocardiography, Doppler echocardiography, Transesophageal echocardiography, Intracardiac echocardiography. […] Procedures that may be used in patients with pericardial effusion include the following: Diagnostic and/or therapeutic pericardiocentesis, Diagnostic pericardioscopy, Placement of a pulmonary artery catheter.

• #43 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] The following lab studies may be performed in patients with suspected pericardial effusion: Electrolytes – To assess for metabolic abnormalities (eg, renal failure). […] It should be noted that routine biochemical and cell-count analysis has a low yield in diagnosing the cause of effusion. In contrast, Gram stain and culture can ascertain the etiology convincingly. […] Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] Patients with viral cardiomyopathy, especially in the acute setting, may have a similar presentation to patients with pericardial effusion, with an enlarged heart being seen on chest radiographs. Echocardiography readily distinguishes the difference between enlarged cardiac chambers and a pericardial effusion.

• #44 Diagnosis and management of pericardial effusion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3110902/

  Although echocardiography is the standard and most available method for the evaluation of pericardial effusion, CT and magnetic resonance imaging (MRI) can offer some advantages. […] When a clinician is faced with a patient who presents with a pericardial effusion, the first challenge is to identify its etiology. […] In many patients the etiology is initially difficult to establish as no apparent cause is present at the time a pericardial effusion is first identified. […] The search for evidence of previous chronic effusion can be particularly helpful, as it may make it possible to distinguish neoplastic disease from chronic idiopathic pericardial effusion, which sometimes presents with tamponade. […] Clinical tamponade is the most severe manifestation of hemodynamic compromise caused by a tense pericardial effusion. […] The prognosis of pericardial effusion depends on the underlying etiology being especially poor in patients with neoplastic pericardial effusion secondary to lung cancer and positive cytologic study (presence of malignant cells) in pericardial fluid.

• #45 Diagnosis and management of pericardial effusion

  https://www.wjgnet.com/1949-8462/full/v3/i5/135.htm

  When a clinician is faced with a patient who presents with a pericardial effusion, the first challenge is to identify its etiology. […] In many patients the etiology is initially difficult to establish as no apparent cause is present at the time a pericardial effusion is first identified. […] The search for evidence of previous chronic effusion can be particularly helpful, as it may make it possible to distinguish neoplastic disease from chronic idiopathic pericardial effusion, which sometimes presents with tamponade. […] Clinical tamponade is the most severe manifestation of hemodynamic compromise caused by a tense pericardial effusion. […] Most pericardial effusions cause abnormalities in hemodynamic parameters as measured in the Cath lab. […] The prognosis of pericardial effusion depends on the underlying etiology being especially poor in patients with neoplastic pericardial effusion secondary to lung cancer and positive cytologic study (presence of malignant cells) in pericardial fluid.

• #46 Diagnosis and management of pericardial effusion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3110902/

  Pericardial effusion is a common finding in everyday clinical practice. The first challenge to the clinician is to try to establish an etiologic diagnosis. Sometimes, the pericardial effusion can be easily related to a known underlying disease, such as acute myocardial infarction, cardiac surgery, end-stage renal disease or widespread metastatic neoplasm. […] The presence of acute inflammatory signs (chest pain, fever, pericardial friction rub) is predictive for acute idiopathic pericarditis irrespective of the size of the effusion or the presence or absence of tamponade. Severe effusion with absence of inflammatory signs and absence of tamponade is predictive for chronic idiopathic pericardial effusion, and tamponade without inflammatory signs for neoplastic pericardial effusion. […] The echocardiogram is the most available and reliable technique in order to verify the presence and the amount of a pericardial effusion; in addition, the echocardiogram offers valuable data for evaluation of hemodynamic repercussion.

• #47 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Pericardial effusion appears as an echo-free space between the visceral and parietal pericardium. […] Echocardiography may identify features that suggest hemodynamically significant cardiac tamponade; however, this is a clinical (not echocardiographic) diagnosis. […] CT scanning can potentially determine the composition of fluid and may detect as little as 50mL of fluid. […] MRI can detect as little as 30 mL of pericardial fluid. […] Early in the course of acute pericarditis, the ECG typically displays diffuse ST elevation in association with PR depression. […] This procedure is used for diagnostic as well as therapeutic purposes. Support for the use of echocardiographic guidance is increasing, unless emergent treatment is required. Indications for pericardiocentesis include impending hemodynamic compromise (ie, pericardial tamponade), suspected infectious or neoplastic etiology, and uncertain etiology. […] This procedure is not universally available. It may increase diagnostic sensitivity in cases of unexplained pericardial effusions, especially for neoplastic disease.

• #48 Pericardial effusion and cardiac tamponade – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pericardial-effusion-and-cardiac-tamponade/

  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. […] Echocardiography is the most important diagnostic procedure and usually reveals an anechoic pericardial space. […] In unstable patients and those in cardiac arrest with suspected tamponade, pericardiocentesis should not be delayed for diagnostic confirmation. […] Echocardiography is a quick and safe diagnostic tool for detecting pericardial effusions and pericardial tamponade. […] Cardiac tamponade is a clinical diagnosis, however, clinical features are poorly sensitive and the diagnosis is often confirmed retrospectively. […] Use POCUS to confirm the presence of a pericardial effusion (see Focused cardiac ultrasound or FAST for techniques).

• #49 Pericardial effusion and cardiac tamponade – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pericardial-effusion-and-cardiac-tamponade/

  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. […] Echocardiography is the most important diagnostic procedure and usually reveals an anechoic pericardial space. […] In unstable patients and those in cardiac arrest with suspected tamponade, pericardiocentesis should not be delayed for diagnostic confirmation. […] Echocardiography is a quick and safe diagnostic tool for detecting pericardial effusions and pericardial tamponade. […] Cardiac tamponade is a clinical diagnosis, however, clinical features are poorly sensitive and the diagnosis is often confirmed retrospectively. […] Use POCUS to confirm the presence of a pericardial effusion (see Focused cardiac ultrasound or FAST for techniques).

• #50 Pericardial effusion and cardiac tamponade – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pericardial-effusion-and-cardiac-tamponade/

  Obtain an urgent bedside echocardiogram to evaluate for echocardiographic findings supportive of cardiac tamponade. […] Perform pericardiocentesis under echocardiographic (or fluoroscopic) guidance without delay in unstable patients unless indications for immediate surgery are present. […] Refer for surgical management if pericardiocentesis is unsuccessful, e.g., due to difficult conditions.

• #51 Diagnosis and management of pericardial effusion

  https://www.wjgnet.com/1949-8462/full/v3/i5/135.htm

  When a clinician is faced with a patient who presents with a pericardial effusion, the first challenge is to identify its etiology. […] In many patients the etiology is initially difficult to establish as no apparent cause is present at the time a pericardial effusion is first identified. […] The search for evidence of previous chronic effusion can be particularly helpful, as it may make it possible to distinguish neoplastic disease from chronic idiopathic pericardial effusion, which sometimes presents with tamponade. […] Clinical tamponade is the most severe manifestation of hemodynamic compromise caused by a tense pericardial effusion. […] Most pericardial effusions cause abnormalities in hemodynamic parameters as measured in the Cath lab. […] The prognosis of pericardial effusion depends on the underlying etiology being especially poor in patients with neoplastic pericardial effusion secondary to lung cancer and positive cytologic study (presence of malignant cells) in pericardial fluid.

• #52 Pericardial effusion and cardiac tamponade – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pericardial-effusion-and-cardiac-tamponade/

  Obtain an urgent bedside echocardiogram to evaluate for echocardiographic findings supportive of cardiac tamponade. […] Perform pericardiocentesis under echocardiographic (or fluoroscopic) guidance without delay in unstable patients unless indications for immediate surgery are present. […] Refer for surgical management if pericardiocentesis is unsuccessful, e.g., due to difficult conditions.

• #53 Diagnosis and management of pericardial effusion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3110902/

  Although echocardiography is the standard and most available method for the evaluation of pericardial effusion, CT and magnetic resonance imaging (MRI) can offer some advantages. […] When a clinician is faced with a patient who presents with a pericardial effusion, the first challenge is to identify its etiology. […] In many patients the etiology is initially difficult to establish as no apparent cause is present at the time a pericardial effusion is first identified. […] The search for evidence of previous chronic effusion can be particularly helpful, as it may make it possible to distinguish neoplastic disease from chronic idiopathic pericardial effusion, which sometimes presents with tamponade. […] Clinical tamponade is the most severe manifestation of hemodynamic compromise caused by a tense pericardial effusion. […] The prognosis of pericardial effusion depends on the underlying etiology being especially poor in patients with neoplastic pericardial effusion secondary to lung cancer and positive cytologic study (presence of malignant cells) in pericardial fluid.

• #54 Diagnosis and management of pericardial effusion

  https://www.wjgnet.com/1949-8462/full/v3/i5/135.htm

  When a clinician is faced with a patient who presents with a pericardial effusion, the first challenge is to identify its etiology. […] In many patients the etiology is initially difficult to establish as no apparent cause is present at the time a pericardial effusion is first identified. […] The search for evidence of previous chronic effusion can be particularly helpful, as it may make it possible to distinguish neoplastic disease from chronic idiopathic pericardial effusion, which sometimes presents with tamponade. […] Clinical tamponade is the most severe manifestation of hemodynamic compromise caused by a tense pericardial effusion. […] Most pericardial effusions cause abnormalities in hemodynamic parameters as measured in the Cath lab. […] The prognosis of pericardial effusion depends on the underlying etiology being especially poor in patients with neoplastic pericardial effusion secondary to lung cancer and positive cytologic study (presence of malignant cells) in pericardial fluid.

• #55 Pericardial Effusion: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17351-pericardial-effusion

  When a pericardial effusion is large or causes cardiac tamponade, it becomes a medical emergency that needs immediate treatment. […] In some cases, surgery is the best way to remove the extra fluid inside your pericardium. […] Your healthcare provider may recommend regular follow-up visits to keep checking the size of the effusion and whether or not it poses any risks to your health. […] Providers can often treat pericardial effusions. […] Overall, effusions that happen for unknown reasons tend to have a good prognosis. […] Your healthcare provider can schedule follow-up visits to monitor your condition, if necessary.

• #56 Pericardial effusion and tamponade – Diagnosis and Treatment Summary : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericardial-effusion-and-tamponade-diagnosis-and-treatment-summary/

  Pericardial fluid analysis and/or pericardium biopsy may be needed to establish the diagnosis. […] Pericardial fluid drainage can be diagnostic as well therapeutic. […] If clinical and point-of-care cardiac ultrasound findings indicate hemodynamic compromise → urgent pericardial drainage is needed. […] Pericardiocentesis under echocardiographic guidance is recommended for most patients. […] Patients with small to moderate pericardial effusions who are hemodynamically stable and without a need for diagnostic fluid sampling can be monitored with serial examinations and echocardiograms.

• #57 Diagnosis of acute pericarditis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis

  Acute pericarditis, the most common pericardial syndrome in clinical practice, is diagnosed based on two of the following criteria: a) chest pain b) pericardial friction-rub c) characteristic ECG changes (new widespread ST-elevation or PR depression) d) pericardial effusion. […] The main diagnostic evaluation consists of medical history (recent viral infection) and physical examination (to detect pericardial rubs at auscultation and additional possible signs of a systemic disease that may be responsible for pericarditis); blood tests (WBCs, ESR, CRP, troponin, complete blood count [CBC], urea, creatinine); ECG; transthoracic echocardiography (TTE); and chest X-ray. […] Acute pericarditis is defined as an 'inflammatory pericardial syndrome with or without pericardial effusion’. […] The diagnosis is clinical and can be made based on two of the following criteria: a) pericardial chest pain in the patients medical history b) pericardial rubs upon auscultation c) new widespread ST-elevation or PR depression on ECG d) pericardial effusion (new or worsening).

• #58 Acute Pericarditis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0401/p553.html

  Acute pericarditis is the most common affliction of the pericardium. […] It is diagnosed in approximately 0.1% of patients hospitalized for chest pain and in 5% of patients admitted to the emergency department for chest pain unrelated to acute myocardial infarction (MI). […] Evaluation of patients with acute pericarditis should include a history, physical examination, electrocardiography, chest radiography, and baseline laboratory studies (i.e., complete blood count, basic metabolic panel, troponin-I and creatine kinase levels, erythrocyte sedimentation rate, and serum C-reactive protein levels). […] Transthoracic echocardiography should be performed in all patients with suspected acute pericarditis to exclude pericardial effusion and cardiac tamponade. […] Diagnosis requires at least two of the following criteria: characteristic sharp, pleuritic chest pain; pericardial friction rub; suggestive changes on electrocardiography; and a new or worsening pericardial effusion.

• #59 Diagnosis and Management of Pericardial Effusion

  https://www.mdpi.com/2392-7674/7/2/23

  Pericardial effusion is a common pathology in clinical practice. […] Transthoracic echocardiography is the gold standard investigation for the diagnosis of pericardial effusions. […] The echocardiographic signs of cardiac tamponade are represented by the collapse of the right atrium and right ventricle, respiratory alteration of mitral and tricuspid flow, and changes of the inferior vena cava. […] This is a review of the diagnosis and treatment of pericardial effusion. […] The European Society of Cardiology guideline for pericardial diseases requires two out of the following four criteria for the diagnosis of acute pericarditis: pericardial chest pain, pericardial rub, ST-segment elevation on ECG and pericardial effusion. […] Transthoracic echocardiography is the most useful investigation for the diagnosis of pericardial effusion. […] Pericardiocentesis guided by echocardiography is a lifesaving procedure in cases of large pericardial effusions and cardiac tamponade.

• #60 Diagnosis of acute pericarditis

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis

  Supportive findings are elevation of inflammatory markers and evidence of pericardial inflammation by computed tomography (CT) or cardiac magnetic resonance (CMR). […] Pericardial effusion, either new appearing or worsening, is typically mild and is evident in 60% of cases. […] Pericardial effusion, based on the size at diastole, is characterised as mild (10 mm), moderate (10-20 mm), or large (20 mm). […] Multimodality imaging is an integral part of an acute pericarditis diagnostic workup and, apart from echocardiography which is considered the first-line test, includes CT and/or CMR (second-line imaging tests). […] The emerging role of new inflammatory markers (i.e. CEACAM1 and MICA) is hopeful.

• #61 Ultrasound Idiots — Pericardial Effusion and Cardiac Tamponade

  https://www.ultrasoundidiots.com/cardiac-tamponade-pericardial-effusion

  Pericardial effusion is an accumulation of fluid within the pericardial sac and can be detected in echocardiography when volume exceeds 15-35cc. […] Cardiac tamponade occurs when the intrapericardial pressure, caused by fluid accumulation, increases to the point at which it impairs cardiac filling (diastolic function) and decreases cardiac output. […] The development of cardiac tamponade is a dynamic process and it is not dependent on the specific size of the effusion but rather the intrapericardial pressure. […] Consequently, asymptomatic pericardial effusions can vary greatly in size and may even exceed 1000 cc without causing tamponade physiology. […] In contrast, tamponade can occur in acute effusions with as little as 150cc. […] The size of an effusion is often reported by gross assessment but can be graded by measurement as: Grade 1 / Small = echo-free space in diastole 10mm, Grade 2 / Moderate = echo-free space in diastole 10-20mm, Grade 3 / Large = echo-free space in diastole 20mm.

• #62 Ultrasound Idiots — Pericardial Effusion and Cardiac Tamponade

  https://www.ultrasoundidiots.com/cardiac-tamponade-pericardial-effusion

  Pericardial effusion is an accumulation of fluid within the pericardial sac and can be detected in echocardiography when volume exceeds 15-35cc. […] Cardiac tamponade occurs when the intrapericardial pressure, caused by fluid accumulation, increases to the point at which it impairs cardiac filling (diastolic function) and decreases cardiac output. […] The development of cardiac tamponade is a dynamic process and it is not dependent on the specific size of the effusion but rather the intrapericardial pressure. […] Consequently, asymptomatic pericardial effusions can vary greatly in size and may even exceed 1000 cc without causing tamponade physiology. […] In contrast, tamponade can occur in acute effusions with as little as 150cc. […] The size of an effusion is often reported by gross assessment but can be graded by measurement as: Grade 1 / Small = echo-free space in diastole 10mm, Grade 2 / Moderate = echo-free space in diastole 10-20mm, Grade 3 / Large = echo-free space in diastole 20mm.

• #63 Diagnosis, treatment, and management of pericardial effusion- review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9283797/

  Pericardiocentesis is not essential for the diagnosis of the underlying cause of pericardial effusion. […] B-TTE allows the effective and timely identification of cardiac abnormalities in emergency situations such as thickened left-ventricular wall, small pericardial effusion, dysfunction of the valvular structures, and cardiac chamber dilations. […] The prognosis of pericardial effusion is determined by the underlying etiology. […] Echocardiography remains the imaging modality of choice for the diagnosis of pericardial effusion.

• #64 The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-021-00205-x

  Given the insidious nature of PCE, evaluation with POCUS could reduce the time-to-diagnosis which had truncated by 39 h in our study. […] In terms of time-to-pericardiocentesis, our data demonstrated the POCUS group received the intervention 21 h earlier than the departmental ECHO group. […] Clinically significant PCE presents with non-specific findings whereby a high degree of clinical suspicion is necessitated. However, POCUS is a readily available bedside diagnostic tool that can quickly rule in the diagnosis.

• #65 Diagnosis and management of pericardial effusion

  https://scholar.valpo.edu/jmms/vol7/iss2/4/

  Pericardial effusion is a common pathology in clinical practice. […] Transthoracic echocardiography is the gold standard investigation for the diagnosis of pericardial effusions. […] This is a review of the diagnosis and treatment of pericardial effusion.

• #66 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  The extent to which pericardial effusions should be evaluated with fluid analysis remains an area of some debate. Initially, in a patient with a new pericardial effusion, the likelihood of myocarditis or pericarditis should be assessed, and the initial diagnostic evaluation should be directed toward these conditions. […] In general, all patients with pericardial tamponade, suspected purulent effusion, or poor prognostic indicators in the setting of pericarditis should undergo diagnostic pericardiocentesis. Those with recurrent effusions or large effusions that do not resolve with treatment of the underlying condition may also warrant fluid analysis. […] Electrocardiographic (ECG) changes are part of the criteria for diagnosing acute pericarditis, and therefore an ECG should be performed at the outset of the evaluation.

• #67 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] The following lab studies may be performed in patients with suspected pericardial effusion: Electrolytes – To assess for metabolic abnormalities (eg, renal failure). […] It should be noted that routine biochemical and cell-count analysis has a low yield in diagnosing the cause of effusion. In contrast, Gram stain and culture can ascertain the etiology convincingly. […] Echocardiography is the imaging modality of choice for the diagnosis of pericardial effusion, as the test can be performed rapidly and in unstable patients. […] Patients with viral cardiomyopathy, especially in the acute setting, may have a similar presentation to patients with pericardial effusion, with an enlarged heart being seen on chest radiographs. Echocardiography readily distinguishes the difference between enlarged cardiac chambers and a pericardial effusion.

• #68 Pericardial effusion and tamponade – Diagnosis and Treatment Summary : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericardial-effusion-and-tamponade-diagnosis-and-treatment-summary/

  Pericardial effusions may develop rapidly (acute) or more gradually (subacute or chronic). […] Signs and symptoms are insensitive and nonspecific for mild pericardial effusions but become more useful in the diagnosis of cardiac tamponade. […] After an ECG and CXR are done, a point-of-care cardiac ultrasound (POCUS) can be used to confirm the diagnosis of a pericardial effusion with 96-100% sensitivity and specificity. […] A formal echocardiogram can also be used to establish the diagnosis. […] Factors that determine the degree of hemodynamic compromise: size of the effusion, rate of fluid accumulation (acute versus subacute/chronic), whether the pericardium is scarred or adherent. […] Often the cause of the pericardial effusion is evident based on history. […] When history and physical exam are not suggestive of a specific diagnosis, routine lab investigations including CBC, chemistry profile, renal function, TSH can be helpful.

• #69 Pericardial Effusion Workup: Approach Considerations, Lab Studies, Chest Radiography

  https://emedicine.medscape.com/article/157325-workup

  Pericardial effusion appears as an echo-free space between the visceral and parietal pericardium. […] Echocardiography may identify features that suggest hemodynamically significant cardiac tamponade; however, this is a clinical (not echocardiographic) diagnosis. […] CT scanning can potentially determine the composition of fluid and may detect as little as 50mL of fluid. […] MRI can detect as little as 30 mL of pericardial fluid. […] Early in the course of acute pericarditis, the ECG typically displays diffuse ST elevation in association with PR depression. […] This procedure is used for diagnostic as well as therapeutic purposes. Support for the use of echocardiographic guidance is increasing, unless emergent treatment is required. Indications for pericardiocentesis include impending hemodynamic compromise (ie, pericardial tamponade), suspected infectious or neoplastic etiology, and uncertain etiology. […] This procedure is not universally available. It may increase diagnostic sensitivity in cases of unexplained pericardial effusions, especially for neoplastic disease.

• #70 Pericardial effusion and cardiac tamponade – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pericardial-effusion-and-cardiac-tamponade/

  Obtain an urgent bedside echocardiogram to evaluate for echocardiographic findings supportive of cardiac tamponade. […] Perform pericardiocentesis under echocardiographic (or fluoroscopic) guidance without delay in unstable patients unless indications for immediate surgery are present. […] Refer for surgical management if pericardiocentesis is unsuccessful, e.g., due to difficult conditions.

• #71 Pericardial effusion and tamponade – Diagnosis and Treatment Summary : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/pericardial-effusion-and-tamponade-diagnosis-and-treatment-summary/

  Pericardial fluid analysis and/or pericardium biopsy may be needed to establish the diagnosis. […] Pericardial fluid drainage can be diagnostic as well therapeutic. […] If clinical and point-of-care cardiac ultrasound findings indicate hemodynamic compromise → urgent pericardial drainage is needed. […] Pericardiocentesis under echocardiographic guidance is recommended for most patients. […] Patients with small to moderate pericardial effusions who are hemodynamically stable and without a need for diagnostic fluid sampling can be monitored with serial examinations and echocardiograms.

• #72 Pericardial Effusion: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/17351-pericardial-effusion

  When a pericardial effusion is large or causes cardiac tamponade, it becomes a medical emergency that needs immediate treatment. […] In some cases, surgery is the best way to remove the extra fluid inside your pericardium. […] Your healthcare provider may recommend regular follow-up visits to keep checking the size of the effusion and whether or not it poses any risks to your health. […] Providers can often treat pericardial effusions. […] Overall, effusions that happen for unknown reasons tend to have a good prognosis. […] Your healthcare provider can schedule follow-up visits to monitor your condition, if necessary.

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