Synopsis
Assess why pericardial fluid has accumulated, define its size and trajectory, recognise tamponade physiology, choose observation, diagnostic sampling or drainage, and coordinate cause-specific care for malignant, purulent and recurrent effusions.
- An effusion is a finding, not a diagnosis. Establish the clinical context, likely cause, echo size, haemodynamic effect and whether the volume is stable, enlarging or recurring.
- Slow accumulation may permit a very large effusion without shock; rapid bleeding can produce tamponade with a much smaller echo measurement.
- TTE should describe distribution, end-diastolic separation, chamber interaction, respiratory Doppler changes, IVC response, ventricular function and comparison with prior studies.
Key red flags
Progressive dyspnoea, tachycardia, raised JVP, narrow pulse pressure, pulsus paradoxus, cool peripheries, oliguria, confusion or rising lactate indicates impaired filling and falling output.
Investigation priorities
Confirm fluid, measure the largest end-diastolic separation in standard views, define circumferential versus loculated distribution and assess haemodynamic effects.
Management branches
A new or previously documented pericardial effusion is identified.
- Assess symptoms, pulse, blood pressure, JVP, perfusion, pulsus paradoxus when appropriate and any precipitating procedure, trauma, infection, renal failure, thyroid disease, autoimmune disease or cancer.
- Obtain TTE and compare with every available prior study. Document distribution, measured size, chamber interaction, respiratory Doppler findings, IVC and ventricular function.
The patient is not in shock but the cause, symptoms, size, trajectory or recurrence may justify intervention.