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INTRODUCTION:
Pericardial effusion is an abnormal accumulation of fluid in the pericardial sac. Normally the pericardial sac contains less than 50 ml of fluid. In case of chronic pericarditis, advanced congestive heart failure or cardiac surgery, there may be chances of escape of more fluid into the pericardial sac. This condition may be referred as Pericardical effusion.
CASE STUDY
PATIENT HISTORY: A 25 year old man got admitted in hospital with the complaint of breathlessness, abdominal distress, cough, on and off temperature for 6 months. On examination, it was found that pallor present, JVP raised, Bronchial breathing and Dressler's sign present, and Hepatomegaly present. He was clinically diagnosed to have congestive cardiac failure with Pericardial effusion.
DEFINITION OF PERICARDIAL EFFUSION:
It is accumulation of fluid in the pericardial'cavity.
ETIOLOGY:
Infective : Viral, Tuberculosis, Pyogenic, Mycotic Syphilitic Non-infective, such as Acute Myocardial infarction, Uremia, Myxedema
III Due to hypersensitivity or auto-immune mechanisms such as Rheumatic Carditis, Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA)
PATHOPHYSIOLOGY:
Pericardial fluid may accumulate slowly without causing noticeable symptoms. A rapidly developing effusion however can stretch the pericardium to its maximum size & can cause decreased cardiac output and decreased venous return to the heart. The result is cardiac tamponade (compression of the heart). The characteristic sign of pericardia! effusion is an extension of flatness on percussion across the anterior aspect of the chest wall. The patient may complain of a feeling of fullness within the chest or have substantial or ill-defined pain.
SIGNS AND SYMPTOMS:
Symptoms:
Fever, Weight loss, Chest pain, Dyspnoea, Dry hacking cough, Hoarseness of voice, Dysphasia.
Signs :
Pulsus paradoxus, Kussamaul's sign - Elevated JVP during inspiration, Apex beat within the cardiac dullness, Dressler's sign - dull percussion note over lower half of sternum, Impaired note in right Cardio hepatic angle [Rotch's sign], Faint or muffled heart sounds, Friction rub, Bronchial breathing below the angle of left scapula (Ewart or Pin sign)
INVESTIGATIONS:
1. X-ray chest PA view - shows cardiomegaly
2. Echocardiography Before pericardiocentesis, cardiac chambers are...