PERICARDIAL EFFUSION - accumulation of fluid in the pericardial sac PATHOPHYSIOLOGY - pericardial sac normally contains about 20ml of fluid

which is needed to decrease friction for the beating heart - an increase in the pericardial fluid raises the pressure within the pericardial sac and compresses the heart - the following are the effects of compression of the heart: > elevated pressure in all cardiac chambers > Decreased venous return due to atrial compression > Inability of the ventricles to distend and fill adequately CLINICAL MANIFESTATIONS - feeling of fullness within the chest - engorged neck veins - SOB - labile or low BP - pulsus paradoxus (systolic BP that is markedly lower during inhalation) ASSESSMENT AND DIAGNOSTIC FINDINGS An echocardiogram is performed to confirm the diagnosis and quantify the amount of pericardial fluid. A chest x-ray may also show a large pericardial effusion. MEDICAL MANAGEMENT > Pericardiocentesis puncture of the pericardial sac to aspirate pericardial fluid. *patient is monitored by continuous ECG *Emergency resuscitation should be ready *head of bed is elevated to 45-60degress *Insert peripheral IV line

>Pericardiotomy recurrent pericardial effusions is treated with pericardiotomy. Under GA, a portion of the pericardium is excised to permit the exudative pericardial fluid to drain into the lymphatic system.