Pathology: Occurs when the pericardial space fills up withfluid faster than it can stretch, resulting in increased pressure within thepericardial sac
As fluid accumulates less bloodenters the ventricles during diastole as the increasing pressure presses on theheart and forces the septum to bend into the left ventricle, this leads todecreased stroke volume and eventually cardiac arrest if left untreated
Aetiology: Causesare similar to that of pericardial effusion
Symptoms: Centralchest pain, shortness of breath, fatigue, cough, syncope
Signs: Sinustachycardia, Kussmaul’s sign, pericardial rub, pulsus paradoxus,
Beck’sTriad - hypotension, raised JVP, muffled heart sounds
Investigations: ECG:Low QRS voltage, electrical alternans (beat-to-beat shift in QRS/P waves)
Chest X-Ray: Large globularheart, cardiomegaly seen with >200 ml of blood
Echo: Systolic collapse of right atriumfollowed by diastolic collapse of right
Ventricle. Fluid accumulates around the heart whichstarts posteriorly.
Treatment: Pericardiocentesis
Opensurgical drainage with pericardiectomy or pericardial window
Complications: Cardiac arrest fromreduced cardiac output
Prognosis: Reduced mortalityand morbidity in early diagnosis and treatment
Figure 1.17 Beck’s Triad
