see also:

• pericarditis
• haemopericardium
• trauma

• accumulation of pericardial fluid under pressure results in impaired cardiac venous filling and resultant impaired cardiac output which may rapidly become life threatening unless relieved by therapeutic pericardiocentesis

• can be suspected based on:
  • history and physical examination
    • near-syncope or syncope
    • hypotension
    • tachycardia
    • elevated JVP
    • pulsus paradoxus
    • peripheral oedema if subacute or chronic aetiology
    • NB. must be differentiated from other conditions such as:
      • acute myocardial infarction (AMI/STEMI/NSTEMI)
      • aortic dissection
      • pulmonary embolism (PE)
      • constrictive pericarditis
      • acute pulmonary oedema (APO)
      • cirrhosis
  • ECG:
    • tachycardia
    • low voltage
    • electrical alternans
  • CXR
    • enlarged cardiac silhouette with clear lung fields
  • rising liver transaminase levels
  • echocardiogram
    • chamber collapses
    • abnormal venous flows
    • exaggerated respiratory variation of cardiac and venous flows
• confirmed by the hemodynamic and clinical response to pericardial fluid drainage