Pericardial effusion

Clinical Presentation

• Pulsus parasoxus: decrease in SBP by 10+ on inspiration (<4 is normal)
  • Results from interventricular interdependence
  • DDx includes asthma exacerbation
• Beck's triad
  • Hypotension
  • Increased JVP
  • Distant heart sounds
• Lungs should be clear to auscultation

Investigations

• EKG shows low-voltage QRS (QRS < 1 big box in limbs leads or <2 big boxes in precordial leads)
  • DDx includes COPD, hypothyroidism, cardiac amyloidosis, and pericardial effusion

Management

• Drain the fluid
  • Ultrasound-guided pericardiocentesis
    • Apical approach safer than subxiphoid
    • Only need to remove 10-15mL fluid to relieve hypotension
  • Pericardial window