Skip to main content
SpringerLink
Log in

Pericardial Effusion and Cardiac Tamponade

  • Chapter
Interventional Pericardiology

  • 810 Accesses

Abstract

Pericardial effusion is defined as the accumulation of fluid in the pericardial space either as transudate (hydropericardium), exudate, pyopericardium or hemopericardium. Large pericardial effusions are most common with neoplastic, tuberculous, cholesterol, uremic pericarditis, myxedema, and parasitoses [1, 2]. Slowly developing pericardial effusions can be asymptomatic even when they are very 1–2 l large, while rapidly accumulating smaller effusions of 150–200 ml can cause fatal tamponade (Fig. 3.1). Loculated effusions occur after surgery, trauma, radiation and purulent infections. Effusions from a hydropericardium are usually small and occur mainly due to heart failure and fluid retention.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Spodick DH. Pericardial diseases. In: Braunwald E, Zipes D, Libby P (eds) Heart disease: a textbook of cardiovascular medicine. Sixth Edition. WB Saunders, Philadelphia, 2001, pp 1823–1876

    Google Scholar 

  2. Sagrista-Sauleda J, Merce J, Permanyer-Miralda G, Soler-Soler J. Clinical clues to the causes of large pericardial effusions. Am J Med 2000; 109(2): 95–101

    Article  PubMed  CAS  Google Scholar 

  3. Soler-Soler J. Massive chronic pericardial effusion. In: Soler-Soler J, Permanyer-Miralda G, Sagrista-Sauleda J (eds) Pericardial diseases – old dilemmas and new insights. Kluwer, Amsterdam, 1990, pp 153–165

    Google Scholar 

  4. Spodick DH. Acute cardiac tamponade. N Engl J Med 2003; 349(7): 684–690

    Article  PubMed  Google Scholar 

  5. Imazio M, Demichelis B, Parrini I, et al. Day-hospital treatment of acute pericarditis: a management program for outpatient therapy. J Am Coll Cardiol 2004; 43(6): 1042–1046

    Article  PubMed  Google Scholar 

  6. Spodick DH. Physiology of cardiac tamponade. In: Spodick DH (ed) The pericardium: a comprehensive textbook. Marcel Dekker, New York, 1997, pp 180–190

    Google Scholar 

  7. Reddy PS, Curtiss EI, Uretsky BF. Spectrum of hemodynamic changes in cardiac tamponade. Am J Cardiol 1990; 66: 1487–1491

    Article  PubMed  CAS  Google Scholar 

  8. Delgado C, Barturen F. Atrial tamponade causing acute ischemic hepatic injury after cardiac surgery. Clin Cardiol 1999; 22(3): 242–244

    Article  PubMed  CAS  Google Scholar 

  9. Ramsaran EK, Benotti JR, Spodick DH. Exacerbated tamponade: Deterioration of cardiac function by lowering excessive arterial pressure in hypertensive cardiac tamponade. Cardiology 1995; 86: 77–79

    Article  PubMed  CAS  Google Scholar 

  10. Sagrista-Sauleda J, Angel J, Sanchez A, Permanyer-Miralda G, Soler-Soler J. Effusive-constrictive pericarditis. N Engl J Med 2004; 350(5): 469–475

    Article  PubMed  CAS  Google Scholar 

  11. Klopfenstein HS, Schuchard GH, Wann LS, et al. The relative merits of pulsus paradoxus and right ventricular diastolic collapse in the early detection of cardiac tamponade: an experimental echocardiographic study. Circulation 1985; 71: 829–833

    Article  PubMed  CAS  Google Scholar 

  12. Shabetai R. Pulsus paradoxus: definition, mechanisms, and clinical association. In: Seferovic PM, Spodick DH, Maisch B (eds) Pericardiology: contemporary answers to continuing challenges. Science, Belgrade, 2000, pp 53–62

    Google Scholar 

  13. Oliver C, Marin F, Pineda J, et al. Low QRS voltage in cardiac tamponade: a study of 70 cases. Int J Cardiol 2002; 83(1): 91–92

    Article  PubMed  Google Scholar 

  14. Gonzalez MS, Basnight MA, Appleton CP, Carucci M, Henry C, Olajos M. Experimental cardiac tamponade: a hemodynamic and Doppler echocardiographic reexamination of the relation of right and left heart ejection dynamics to the phase of respiration. J Am Coll Cardiol 1991; 18: 143–152

    Article  Google Scholar 

  15. Toney JC, Kolmen SN. Cardiac tamponade: fluid and pressure effects on electrocardiographic changes. Proc Soc Biol Med 1966; 12: 642–648

    Google Scholar 

  16. Karatay CM, Fruehan CT, Lighty GW, Jr, Spear RM, Smulyan H. Acute epicardial distension in pigs: effect of fluid conductance on body surface electrocardiogram QRS size. Cardiovasc Res 1993; 27: 1033–1038

    Article  PubMed  CAS  Google Scholar 

  17. Brody DA. A theoretical analysis of intracavitary blood mass influence on the heart-lead relationship. Circ Res 1956; 4: 731–738

    PubMed  CAS  Google Scholar 

  18. Bruch C, Schmermund A, Dagres N, et al. Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment. J Am Coll Cardiol 2001; 38(1): 219–226

    Article  PubMed  CAS  Google Scholar 

  19. Rushmer RF. Cardiovascular dynamics. WB Saunders, Philadelphia, PA, 1970, pp 76–81

    Google Scholar 

  20. Schlant RC, Hurst MD. Advances in electrocardiography. Grune and Stratton, New York, NY, 1976, pp 4–6

    Google Scholar 

  21. Friedman HS, Lajam F, Calderon J, Zaman Q, Marino ND, Gomes JA. Electrocardiographic features of experimental cardiac tamponade in closed-chest dogs. Eur J Cardiol 1977; 6: 311–322

    PubMed  CAS  Google Scholar 

  22. Eisenberg MJ, Dunn MM, Kanth N, Gamsu G, Schiller NB. Diagnostic value of chest radiography for pericardial effusion. J Am Coll Cardiol 1993; 22: 588–593

    Article  PubMed  CAS  Google Scholar 

  23. Torrance DJ. Demonstration of subepicardial fat as an aid in the diagnosis of pericardial effusion or thickening. Am J Roentgenol 1955; 74: 850–855

    CAS  Google Scholar 

  24. Kremens V. Demonstration of the pericardial shadow on the routine chest roentgenogram: a new roentgen finding. Radiology 1955; 64: 72–80

    PubMed  CAS  Google Scholar 

  25. Holt JF. Epicardial fat shadows in differential diagnosis. Radiology 1947; 48: 472–479

    PubMed  CAS  Google Scholar 

  26. Lane EJ Jr, Carsky EW. Epicardial fat: Lateral plain film analysis in normals and in pericardial effusion. Radiology 1968; 91(1): 1–5

    PubMed  Google Scholar 

  27. Carsky EW, Mauceri RA, Azimi F. The epicardial fat pad sign: analysis of frontal and lateral chest radiographs in patients with pericardial effusion. Radiology 1980; 137(2): 303–308

    PubMed  CAS  Google Scholar 

  28. Woodring JH. The lateral chest radiograph in the detection of pericardial effusion: a reevaluation. J Ky Med Assoc 1998; 96(6): 218–224

    PubMed  CAS  Google Scholar 

  29. Heinsimer JA, Collins GJ, Burkman MH, Roberts L Jr, Chen JT. Supine cross-table lateral chest roentgenogram for the detection of pericardial effusion. JAMA 1987; 257(23): 3266–3268

    Article  PubMed  CAS  Google Scholar 

  30. Spooner EW, Kuhns LR, Stern AM. Diagnosis of pericardial effusion in children: a new radiographic sign. Am J Roentgenol 1977; 128(1): 23–25

    CAS  Google Scholar 

  31. Tehranzadeh J, Kelley MJ. The differential density sign of pericardial effusion. Radiology 1979; 133(1): 23–30

    PubMed  CAS  Google Scholar 

  32. Maisch B, Ristic AD. Tangential approach to small pericardial effusions under fluoroscopic guidance in the lateral view: The halo phenomenon [abstract]. Circulation 2001; 103(Suppl. A): II-730

    Google Scholar 

  33. Horowitz MDS, Schultz CS, Stinson EB, Harrison DC, Popp RL. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion. Circulation 1974; 50: 239–245

    PubMed  CAS  Google Scholar 

  34. Tsang TS, Oh JK, Seward JB, Tajik AJ. Diagnostic value of echocardiography in cardiac tamponade. Herz 2000; 25(8): 734–740

    Article  PubMed  CAS  Google Scholar 

  35. Singh S, Wann LS, Schuchard GH, et al. Right ventricular and right atrial collapse in patients with cardiac tamponade – a combined echocardiographic and hemodynamic study. Circulation 1984; 70(6): 966–971

    Article  PubMed  CAS  Google Scholar 

  36. Merce J, Sagrista-Sauleda J, Permanyer-Miralda G, Evangelista A, Soler-Soler J. Correlation between clinical and Doppler echocardiographic findings in patients with moderate and large pericardial effusion: implications for the diagnosis of cardiac tamponade. Am Heart J 1999; 138 (4 Pt 1): 759–764

    Article  PubMed  CAS  Google Scholar 

  37. Ionescu A, Wilde P, Karsch KR. Localized pericardial tamponade: difficult echocardiographic diagnosis of a rare complication after cardiac surgery. J Am Soc Echocardiogr 2001; 14: 1220–1223

    Article  PubMed  CAS  Google Scholar 

  38. Joffe II, Jacobs LE, Kotler MN. Images in cardiovascular medicine. Pericardial tamponade. Circulation 1996; 94(10): 2667

    CAS  Google Scholar 

  39. Cikes I. Pericardial disease. In: Roelandt JRTC, Sutherland GR, Ilicento S, Linker DT (eds) Cardiac ultrasound. Livingstone, Edingburgh, 1993, pp 543–556

    Google Scholar 

  40. D´Cruz IA, Cohen HC, Prabhu R, Glick G. Diagnosis of cardiac tamponade by echocardiography. Changes in mitral valve motion and ventricular dimensions, with special reference to paradoxical pulse. Circulation 1975; 52: 460–465

    Google Scholar 

  41. Ristić AD, Kušić-Pajić A, Seferović PM, et al. Is two-dimensional echocardiography sensitive and specific enough to diagnose cardiac tamponade? Eur Heart J 2002; 23(Suppl.): 3307

    Google Scholar 

  42. Oh JK, Hatle LK, Mulvagh SL, Tajik AJ. Transient constrictive pericarditis: diagnosis by two-dimensional Doppler echocardiography. Mayo Clin Proc 1993; 68: 1158–1164

    PubMed  CAS  Google Scholar 

  43. Togni M, Shabetai R, Blanchard D. Color M-mode Doppler flow propagation velocity in cardiac tamponade. J Am Coll Cardiol 2001; 37(1): 328–329

    Article  PubMed  CAS  Google Scholar 

  44. Nishikawa Y, Roberts JP, Talcott MR, Dysko RC, Tan P, Klopfenstein HS. Accelerated myocardial relaxation in conscious dogs during acute cardiac tamponade. Am J Phys 1994; 266(5 Pt 2): H1935–1943

    CAS  Google Scholar 

  45. Murgo JP, Uhl GS, Felter HG. Right and left heart ejection dynamics during pericardial tamponade in man. In: Reddy PS, Leon DF, Shaver JA (eds) Pericardial disease. Raven Press, New York, 1982, pp 189–201

    Google Scholar 

  46. Spodick DH. Low atrial natriuretic factor levels and absent pulmonary edema in pericardial compression of the heart. Am J Cardiol 1989; 63: 1271–1272

    Article  PubMed  CAS  Google Scholar 

  47. Shabetai R, Fowler NO, Guntheroth WG. The hemodynamics of cardiac tamponade and constrictive pericarditis. Am J Cardiol 1970; 26: 480–489

    Article  PubMed  CAS  Google Scholar 

  48. Maisch B, Seferovic PM, Ristic AD, et al. Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. Guidelines on the diagnosis and management of pericardial diseases. Executive summary. Eur Heart J 2004; 25(7): 587–610

    Article  PubMed  Google Scholar 

  49. Gascho JA, Martins JB, Marcus ML, Kerber RE. Effects of volume expansion and vasodilators in acute pericardial tamponade. Am J Physiol 1981; 240: H49–H53

    PubMed  CAS  Google Scholar 

  50. Spodick DH. Medical treatment of cardiac tamponade. In: Caturelli G (ed) Cura intensiva cardiologica. TIPAR Poligrafica, Rome, 1991, pp 265–268

    Google Scholar 

  51. Hashim R, Frankel H, Tandon M, Rabinovici R. Fluid resuscitation- induced cardiac tamponade. Trauma 2002; 53: 1183–1184

    Article  Google Scholar 

  52. Cooper JP, Oliver RM, Currie P, Walker JM, Swanton RH. How do the clinical findings in patients with pericardial effusions influence the success of aspiration? Br Heart J 1995; 73: 351–354

    Article  PubMed  CAS  Google Scholar 

  53. Nugue O, Millaire A, Porte H, et al. Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients. Circulation 1996; 94(7): 1635–1641

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine – Cardiology, Philipps University Marburg, Marburg, Germany

    Bernhard Maisch MD, FESC, FACC (Professor of Internal Medicine – Cardiology, Director)

  2. Department of Cardiology, Institute of Cardiovascular Diseases, Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, Serbia

    Arsen D. Ristić MD, PhD, FESC (Associate Professor of Internal Medicine – Cardiology)

  3. Department of Cardiology Clinical Center of Serbia, Belgrade University School of Medicine, Belgrade, Serbia

    Petar M. Seferović MD, PhD, FESC, FACC (Professor of Internal Medicine – Cardiology)

  4. Diamond Health Care Centre, University of British Columbia, 2775 Laurel Street, BC V5Z 1M9, Vancouver, Canada

    Teresa S. M. Tsang MD, FACC (Professor of Medicine)

Authors
  1. Bernhard Maisch MD, FESC, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arsen D. Ristić MD, PhD, FESC
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Petar M. Seferović MD, PhD, FESC, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Teresa S. M. Tsang MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Medizin Verlag Heidelberg

About this chapter

Cite this chapter

Maisch, B., Ristić, A.D., Seferović, P.M., Tsang, T.S.M. (2011). Pericardial Effusion and Cardiac Tamponade. In: Interventional Pericardiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11335-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-11335-2_3

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-11334-5

  • Online ISBN: 978-3-642-11335-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation