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A pericardial effusion is a collection of fluid that collects between the walls of the heart and the pericardium. This area is called the pericardial space and typically contains a small amount of fluid which lubricates the heart. An abnormal accumulation of fluid in this space is known as a pericardial effusion. Pericardial effusions can be chronic (accumulate over weeks, months, years) or acute (rapid accumulation of blood in the setting of trauma). Pericardial effusions that accumulate quickly can lead to cardiac tamponade. Cardiac tamponade results in an equilization of pressures across all 4 chambers of the heart leading to right ventricular collapse, decrease preload, and decreased cardiac output. Cardiac tamponade is an life-threatening emergency that can lead to severe cardiac dysfunction and death if not quickly addressed.
The diagnosis of cardiac tamponade can be made on bedside ultrasound. You first need to visualize the heart in any view (subxiphoid, parasternal long, apical) and evaluate for a pericardial effusion. A pericardial effusion is best visualized on the subxiphoid view. Fluid has the appearance of an anechoic area on ultrasound. In the case of a pericardial effusion, the anechoic area will encircle the heart. You will be able to visualize the anechoic fluid between the heart and the pericardium which both appear bright white.
Steps to diagnose cardiac tamponade:
For patients with cardiac tamponade an emergenct pericardiocentesis should be performed to drain the fluid and improve cardiac output.
Items needed for performing a pericardiocentesis include:
Performing the procedure:
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