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Pathology

Occurs when the pericardial space fills up with fluid faster than it can stretch, resulting in increased pressure within the pericardial sac 
As fluid accumulates less blood enters the ventricles during diastole as the increasing pressure presses on the heart and forces the septum to bend into the left ventricle, this leads to decreased stroke volume and eventually cardiac arrest if left untreated


Aetiology

Causes are similar to that of pericardial effusion

Signs

Sinus tachycardia, Kussmaul’s sign, pericardial rub, pulsus paradoxus, 
Beck’s Triad - hypotension, raised JVP, muffled heart sounds 


Symptoms

Central chest pain, shortness of breath, fatigue, cough, syncope

Investigations

ECG: Low QRS voltage, electrical alternans (beat-to-beat shift in QRS/P waves)
Chest X-Ray: Large globular heart, cardiomegaly seen with >200 ml of blood
Echo: Systolic collapse of right atrium followed by diastolic collapse of right 
Ventricle. Fluid accumulates around the heart which starts posteriorly.

Treatment

Pericardiocentesis 
Open surgical drainage with pericardiectomy or pericardial window

Prognosis

Reduced mortality and morbidity in early diagnosis and treatment
Cardiac arrest from reduced cardiac output

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