Presentation:
The most common presentation is Dyspnea and Tachypnea
In the later stages the patient may even end up arresting with PEA (pulseless electrical activity)
Signs:
Classical becks triad:
Jugular venous distension
Distant heart sounds
Hypotension
Other signs include: Pulsus paradoxus (drop of SBP of greater than 10mmhg on inspiration), low voltages on ECG, electrical alterans, cardiomegaly on CXR.
Risk factors:
Metastatic cancer, mediastinal radiation, end stage renal disease, recent surgery, tuberculosis
This list is very similar to the list of etiologies:
Malignancy, radiation, uremia, dialysis, infection, idiopathic, iatrogenic, post AMI.
Diagnosis:
Clinical diagnosis, best with ultrasound.
On ultrasound you may see; a dilated IVC without changein size on respiration, right ventricle collapse (in fact you may see collapse of any of the chambers).
Treatment:
Pericardiocentesis, depending on ultrasound findings and the expertise of operator, most often performed in the subxiphoid position, with a spinal needle aimed at 45 degrees towards to the left shoulder. Ultrasound is used to guide a spinal needle (keep the needle lateral to the probe so it is always in view, the same plane) into the pericardial sac, avoiding the myocardium. A guidewire and catheter can be positioned to facilitate the drainage. In an emergency setting the procedure can be performed blind or with the help of ECG lead attached to the needle (if you see ST segment elevation then you have gone too far).
Complications of pericardiocentesis: pneumothorax, coronary artery injury, liver or stomach injury, dysrhythmias,
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