Pericardial Effusion - Indication
Indication
Pericardial effusion is generally asymptomatic. Even when symptoms develop, the complaints are non-specific. Classical physical examination findings are seldom found. In fact, Beck's triad was originally derived from acute pericardial effusion. He noted these findings dissipated and not as prevalent in chronic effusion.
POCUS offers a rapid
diagnostic assessment to answer the simple question: "Is there a pericardial effusion?"
The most common indication
is shock assessment. Obstructive shock is often missed, and the physical exam hinges on visibility of the heightened JVP.
Other less common indications are in subacute settings when the pretest probability is intermediate especially when there are features suggestive of a pericardial effusion:
- Enlarge cardiac silouette on CXR
- Low ECG voltages
- Electric alternans
Tamponade physiology assessment can be achieved with POCUS though it is more complex. This will be further discussed in the Tamponade section.
Take Home Messages:
- Pericardial effusion is elusive
- POCUS rapidly tells you whether an effusion is present or not
- Detection of an effusion vs tamponade physiology are two distinct
clinical questions