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A Systematic Approach to Evaluation of Pericardial Effusion and Cardiac Tamponade

Schairer, John R. DO; Biswas, Santanu MD; Keteyian, Steven J. PhD; Ananthasubramaniam, Karthikeyan MD

doi: 10.1097/CRD.0b013e31821e202c
Review Article

Pericardial disease leading to pericardial effusion (PEF) is a common condition encountered by the clinician in day-to-day practice. If the PEF becomes large enough, it can cause hemodynamic compromise, resulting in a cardiogenic shock state known as cardiac tamponade. There are many clinical and echocardiographic signs that a clinician can use to assess whether a large PEF is hemodynamically significant. However, these signs can be either conflicting or even absent. The purpose of this review is to first, describe the physiology of the pericardium in health and how it changes with disease; second, outline the pathophysiology of pericardial tamponade and discuss how it is responsible for the physical and echocardiographic findings of cardiac tamponade; and third, suggest an approach to applying these findings in a systematic order to ensure a correct diagnosis.

From the Department of Internal Medicine, Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI.

The authors declare no conflict of interest.

Correspondence: John R. Schairer, DO, Department of Medicine, Heart and Vascular Institute, Henry Ford Hospital, K-14, Detroit, MI 48202. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.