Pericardial disease and pericardial tamponade

Abstract

The pericardium serves many important functions, but it is not essential for life. Pericardial heart disease comprises only pericarditis and its complications, tamponade and constriction, and congenital lesions. However, the pericardium is affected by virtually every category of disease. The critical care physician is thus likely to encounter the patient with pericardial disease in a variety of settings, either as an isolated phenomenon or as a complication of a variety of systemic disorders, trauma, or certain drugs. Echocardiography is the primary tool for diagnosing and quantifying pericardial effusions, and in the context of the clinical presentation, a thorough understanding of M-mode, two-dimensional, and Doppler findings can help not only to identify patients with impending tamponade, but also to suggest a diagnosis of constrictive pericarditis. This article reviews the pathogenesis and diagnosis of pericardial heart disease, focusing on the diagnostic utility of echocardiography, with an emphasis on those areas of greatest interest to the intensivist.

Pericardial Diseases

“…According to 2004 European Society of Cardiology guidelines, cardiac tamponade is defi ned as the decompensated phase of cardiac compression caused by effusion accumulation and the resultant increased intrapericardial pressure [ 7 ]. Cardiac tamponade presents with equal elevation of atrial and pericardial pressure, an exaggerated inspiratory decrease in arterial systolic pressure (pulsus paradoxus), distended jugular veins, and arterial hypotension [ 16 ].…”

Watermelon stomach, hemorrhagic pericarditis, small cell carcinoma of the lung and synchronous squamous cell carcinoma of the tongue base

“…Complications are also rarer with EBL than with APC 27 . The main causes of non-traumatic hemorrhagic pericarditis are tuberculosis in deveEstômago em melancia, pericardite hemorrágica, tumor de pequenas células do pulmão e carcinoma pavimentocelular síncrono da base da língua 31,32,33,34,35,36,37,38,39 . In a review of 127 patients with malignancy-related pericardial effusion by Wilkes 40 , 55% of cases were malignant in etiology while in the remaining 45%, a malignant cause for the effusion could not be determined and no definitive etiology was identified in 74% of these effusions.…”

Alternancia Eléctrica

“…En nuestro caso, se trata de un síndrome de Dressler, que cursó con ligero-moderado derrame pericárdico, sin derrame pleural asociado, y sin datos clínicos de taponamiento cardiaco, lo que hubiera exigido una pericardiocentesis evacuadora 6 . La búsqueda y confirmación del derrame pericár-dico puede hacerse en Atención Primaria mediante ecocardiografía básica con un entrenamiento míni-mo.…”

“…Cuando el derrame pericárdico es abundante puede haber un excesivo movimiento del corazón dentro del saco pericárdico y debido a ello el corazón no recupera su posición original antes de la siguiente despolarización eléctrica, por lo que el eje del complejo QRS varía, apareciendo la AE en el electrocardiograma 6,7 .…”