Pericardial Effusions-Self Assessment
MedEducation Flix – Pericardial Effusion & Tamponade Self-Assessment
1. What is Beck's triad?
Hypotension, muffled heart sounds, and elevated JVP – classic for cardiac tamponade.
2. What ECG finding is classically associated with large pericardial effusion?
Electrical alternans – beat-to-beat variation in QRS amplitude.
3. How does cardiac tamponade impair cardiac function?
External compression reduces ventricular filling, decreasing stroke volume and cardiac output.
4. What is pulsus paradoxus and how is it assessed?
Drop in systolic BP >10 mmHg during inspiration; measured with sphygmomanometry. an arterial line or Doppler ECHO
5. Which imaging modality is most sensitive for pericardial effusion?
Echocardiography.
6. What are the echocardiographic signs of tamponade physiology?
RA or RV diastolic collapse, dilated IVC, exaggerated respiratory variation in mitral/tricuspid inflow.
7. When is CT or MRI preferred over echo for pericardial effusion?
When loculated effusions or pericardial masses are suspected.
8. What are common causes of pericardial tamponade?
Malignancy, uremia, infection (including TB), post-MI, trauma, iatrogenic.
9. What is the initial management priority in suspected tamponade?
Urgent echocardiography to confirm diagnosis, followed by pericardiocentesis if unstable.
10. What is pericardial decompression syndrome?
Acute LV failure and pulmonary edema after sudden removal of large effusion; likely due to interventricular dependence and sudden preload shift.
11. How is pericardiocentesis performed safely?
Ultrasound-guided subxiphoid or apical approach; continuous ECG and hemodynamic monitoring.
12. When is pericardial window or surgical drainage indicated?
Recurrent effusions, loculated effusions, or failed pericardiocentesis.
13. What are contraindications to blind pericardiocentesis?
Uncertain diagnosis, coagulopathy, or lack of emergent setting.
14. How could cardiac tamponade be differentiated from a possible massive PE by the bedside, in a shocked patient?
Echo findings: tamponade has chamber collapse; PE shows RV strain/dilation with normal pericardium.
15. When should you insist on the Cath Lab involvement, in tamponade?
Post-procedural tamponade during PCI or pacemaker placement; immediate cath lab drainage may be lifesaving.
16. Why might an IV fluid bolus be given before pericardiocentesis?
To temporarily augment preload and maintain perfusion until drainage.
17. What is the role of pericardial catheter after drainage?
Allows ongoing drainage, reduces reaccumulation, enables cytology or culture.
18. What is the typical fluid analysis profile of malignant effusion?
Exudate with high protein, LDH, and positive cytology.
19. What are complications of pericardiocentesis?
Coronary artery or myocardial puncture, arrhythmias, pneumothorax, infection.
20. How is pericardial effusion managed in stable patients?
Monitor with serial echocardiograms, treat underlying cause, avoid invasive drainage unless signs of tamponade.