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PERICARDIAL EFFUSION
Present by:
Sharifah Faseha
Supervisor:
dr. Abdul Hakim Alkatiri, SpJP.FIHA
Cardiology Department
Medical Faculty
Hasanuddin University
Case Report
2013
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History Taking
Chief complaint: Shortness of breath
Further anamnesis: It was felt since 3 days
before she was admitted to the hospital.
Dyspnea (+), DOE(+), PND (+), Orthopnea(+),
chest pain(+) occur along with SOB.nausea(-),
vomiting (-), fever(-) Urination and defecation
were normal.
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History of past illness
History of hypertension (-)
History of Diabetes Mellitus (-)
History of heart disease (-) Family history of heart disease (-)
History of breast cancer (+) undergone total
right mastectomy
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Clinical Examination
General condition:
moderate illness/ normal weight/ conscious
Vital Sign
BP: 120/80 mmHg R : 26x/minHR: 88 bpm T : 36,8oC (afebrile)
Head: anemia (-), jaundice (-)
Neck: JVP R+3cm H20
Lung: BS: bronchovesicular
Rh -/- basal Wh -/-
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Clinical Examination
Cardiac Examination
Inspection : Ictus cordis wasntvisible
Palpation : Ictus cordis wasntpalpable.
Percussion : Right heart border in right
parasternalis line, left heart border one finger
from left midclavicle line ICS V.
Auscultation : Heart Sounds = S I/II regular.
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Clinical Examination
Abdominal Examination
Inspection : Flat, following breath movement
Auscultation : Peristaltic sound (+), normal
Palpation : Liver and spleen are unpalpable Percussion : Tympani (+)
Extremities
Oedema pretibial -/-
Oedema dorsum pedis -/-
Cyanosis (-), Clubbing finggers (-)
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Electrocardiogram on 25th April 2013
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ECG Interpretation
Rhythm : Sinus Rhythm
HR / QRS rate : 100bpm
Axis : Normoaxis
Regularity : Regular
P wave : 0,08 s
PR interval : 0,12 s
QRS complex : 3 small squares (0,12 s)
ST segment : Normal
Conclusion : Sinus rhythm, HR 100bpm, normoaxis
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Laboratory Findings
Test Result Normal Value
WBC 7,75 [10^3u/L] 4,010,0
RBC 4,38 [10^6u/L] 4,06,0
HGB 11,4 [g/dL] 13,017,0
HCT 35,9 [%] 40,054,0
PLT 309 [10^3u/L] 150 - 500
Ureum 14 [mg/dL] 10 - 50
Creatinine 0,6 [mg/dL] M(
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Chest X-Ray
Duplex pulmonarytuberculosis
Cardiomegaly with
dilatation of aorta
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Echocardiogram
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Echocardiogram description
Good LV systolic function. EF 81%
Hyperkinetic
RA.RV collapse
Heart valves : Mitral: Good function and movement
: Aorta : 3cuspis. Calcification (-).Good function and movement
: Tricuspid : Good function andmovement
: Pulmonal : Good function andmovement
Conclusion : Impending cardiac temponade
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Working Diagnosis
Pericardial Effusion
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Therapy
IVFD Nacl 0,9% 500cc
Ceftriaxone 2gr/24hrs/iv (antibiotic)
Pericardiocenthesis
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Planning
Cytology analysis of pericardial fluid
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DISCUSSION
PERICARDIAL EFFUSION
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Pericardium
Fibrous sac surrounding heart-dense network ofcollagen fibres
Serous membranetwo continuous layersseparated by a small amount of fluid lubricant (30-50mls straw coloured (serous fluid))
Layers are called visceral and parietal Visceral is inner layer (epicardium)
Parietal is continuous with diaphragm and outer walls ofgreat arteries
Surrounds the heart Continuous with the great arteries and the
diaphragm
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What is its function?
Stabilises the position of the heart within the
chest
Prevents friction between the moving heart
and adjacent structures
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Pericardial effusion
Pericardial effusion("fluid around the heart")
is an abnormal accumulation of fluid in
the pericardial cavity. Because of the limited
amount of space in the pericardialcavity, fluid accumulation leads to an
increased intrapericardial pressure which can
negatively affect heart function.
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Causes
Infective (viral or bacterial)
Following a myocardial infarction or cardiac surgery
Radiation therapy
Neoplastic disease (commonly lung or breast)
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Pathophysiology
Inflammation of pericardium due to infectionmetastasis process or lymphatic obstruction
Disturb the equilibrium between the production and
re-absorption of pericardial fluid
Pericardium exude fluid, fibrin, blood cells.
Increases fluid volume in pericardial space
Pericardial effusion
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Investigations and clinical signs
Clinical examinationSOB, orthopnoea, tachycardia(varying degrees)
Auscultationmay have muffled heart sounds
ECG may show low amplitude QRS complexes and
alternating axis CXRglobular appearance to heart and therefore
increased cardiothoracic ratio
Echosize of effusion and haemodynamic effect of it
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CXR
Being describe aswater bottle heart
shape
Widening of cardiac
sillhoutte
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Echocardiogram
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Treatment
Depends on the underlying cause and the severity of theheart impairment.
If the pericardial effusion is due to a condition such as lupus,
treatment with anti-inflammatory medications may help.
If the effusion is compromising heart function and causingcardiac tamponade, it will need to be drained, most
commonly by a needle inserted through the chest wall and
into the pericardial space called pericardiocentesis.
In some cases, surgical drainage may be required by cuttingthrough the pericardium creating a pericardial window, which
allows ongoing drainage of fluid externally or internally such
as into the pleural cavity
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Additional info
Pericardial effusion develops in 5% to 15% of patients withcancer and is sometimes the initial manifestation ofmalignancy.
Most pericardial effusions in cancer patients result fromobstruction of the lymphatic drainage of the heartsecondary to metastases.
The typical presentation is that of a patient with knowncancer who is found to have a large pericardial effusionwithout signs of inflammation.
The most common malignant causes of pericardialeffusions are lung and breast cancers, leukemias(specifically acute myelogenous, lymphoblastic, and chronicmyelogenous leukemia [blast crisis]), and lymphomas.
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