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Pathophysiology and causes of pericardial tamponade 

Pathophysiology and causes of pericardial tamponade
Chapter:
Pathophysiology and causes of pericardial tamponade
Author(s):

John R. Schairer

and Steven J. Keteyian

DOI:
10.1093/med/9780199600830.003.0166
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date: 24 February 2020

Pericardial disease leading to pericardial effusion (PEF) is a common clinical disorder. The most common causes are viral infections, metastatic cancer, renal disease, and bleeding disorders. PEF that accumulates slowly can become quite large before haemodynamic embarrassment occurs, while PEF that accumulates rapidly from trauma or aortic dissection can be small,yet cause haemodynamic embarrassment. As the PEF increases in size, the pressure in the pericardial space increases, leading to a decrease in atrial and ventricular chamber sizes, and limiting filling of the chambers. Ultimately, cardiac output is decreased,resulting in cardiac tamponade. When the limits of the pericardial stretch are reached, the volume in the pericardial sac becomes fixed. Any additional increase of PEF results in decreased cardiac size and any change in chamber size with respiration results in a paradoxical change in size of the other chambers. Tamponade is divided into three phases based on changes in pericardial and arterial pressure and cardiac output. Doppler echocardiography is the cornerstone of the diagnosis, follow-up, and management of PEF. It provides information about the presence, size, and location of the PEF, its impact on right ventricle, right atrium, and inferior vena cava size, and assesses tamponade physiology. Comorbid conditions may modify the signs of tamponade and need to be considered during the clinical assessment. Tamponade is not an all-or-nothing diagnosis, but instead should be viewed along a continuum of progressively worsening haemodynamics.

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