In this episode, we cover pericardial effusion, the accumulation of fluid within the pericardial sac, and its progression to cardiac tamponade, a life-threatening emergency. We break down the pathophysiology of increased intrapericardial pressure impairing ventricular filling, emphasizing how the rate of fluid accumulation is just as critical as volume. Common etiologies—including infection, malignancy, autoimmune disease, uremia, and post-MI syndromes—are reviewed alongside key clinical presentations such as dyspnea, chest pain, and fatigue. We highlight classic exam findings of tamponade, including Beck's triad (hypotension, JVD, muffled heart sounds) and pulsus paradoxus. Diagnostic strategies focus on echocardiography as the gold standard, with supportive EKG and imaging findings. Management ranges from treating underlying causes in stable cases to emergent pericardiocentesis in tamponade. High-yield pearls emphasize rapid recognition to prevent hemodynamic collapse and death.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Klein AL, Abbara S, Agler DA, et al. Evaluation and management of pericardial disease. JAMA. 2021;325(10):1022–1036.
3. Imazio M, Adler Y. Management of pericardial effusion. Nature Reviews Cardiology. 2020;17(11):698–7123
4. Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. European Heart Journal. 2015;36(42):2921–2964.