AM cardiology report PEARLS 1/19: ddx for new pericardial effusions!

Take-home point #1 (on diagnosis): for new pericardial effusions, fluid is low yield for diagnosis – you need pericardial tissue! However, low glucose can be helpful; ddx RA or bacterial infection!

 

Take-home point #2 (on management): Do not be afraid of diuresing post-drainage. Patients with tamponade physiology are preload dependent, however, rapid fluid reaccumulation after drainage is very rare.

 

New pericardial effusion ddx

  • Post-MI most common
  • Collagen vascular disease, esp SLE and RA
  • Trauma/surgical
  • Metastatic disease
  • Infection
    • Viral
    • TB (think of this in immunocompromised patients)
    • Cocci
    • Bacterial (*Patients with bacterial pericarditis often appear very sick!)
      • Most common causes of bacterial pericarditis:
        • Mediastinitis
        • Post-op after sternotomy
        • Direct extension from endocarditis
        • Hematogenous spread
      • Uremia
      • Coagulopathy
      • Hypothyroidism
      • Drugs
      • Here is a nice image from an article on “Diagnosis and management of pericardial effusion”: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110902/pdf/WJC-3-135.pdf
      • pericardial effusion

 

Other misc teaching points from the case

  • Whenever you see fibrinous tissue around the pericardial effusion on TTE, it has likely been accumulating for weeks
  • Only 2% of patients with total knee replacement develop hardware infections (though at UCSF we see a disproportionate number of these!)

 

Evernote: https://www.evernote.com/shard/s34/sh/71592c7d-676c-4085-a8f0-786e17152053/dfbefc837c1328744d4e149520f8807c

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