Why does pericardial effusion cause abnormal pulses?

Written by Cai Li E

Cardiology

Updated on October 23, 2024

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Pulsus paradoxus refers to a condition where the pulse weakens significantly or disappears during inhalation, caused by a decrease in the left ventricular stroke volume. Normally, the strength of the pulse is not affected by the respiratory cycle. However, when cardiac tamponade, significant pericardial effusion, or constrictive pericarditis occurs, inhalation can restrict the relaxation of the right heart, leading to a reduced volume of blood returning to the heart and affecting the right heart’s output. Consequently, the amount of blood the right ventricle pumps into the pulmonary circulation is reduced. Furthermore, the pulmonary circulation is affected by the negative thoracic pressure during inhalation, causing pulmonary vessels to dilate and reducing the volume of blood returning from the pulmonary veins to the left atrium. Therefore, the output of the left heart also decreases. These factors lead to a weakened pulse during inhalation, which can sometimes be imperceptible, also known as pulsus paradoxus. This condition can be identified by a significant drop in systolic pressure by more than 10mmHg during inhalation compared to exhalation.

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Written by Li Hai Wen

Cardiology

50sec

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Can pericardial effusion cause chest pain?

Pericardial effusion can cause chest pain because patients with pericardial effusion have limited cardiac diastolic expansion, resulting in a restricted blood volume during the cardiac diastolic phase. This ultimately causes reduced cardiac pumping, leading to symptoms of ischemia and hypoxia, such as chest tightness or chest pain. Furthermore, as the amount of pericardial effusion decreases, for example from moderate or large volumes to a small amount, chest pain symptoms can also occur. This is because when the volume of pericardial effusion significantly reduces, there can often be friction between the visceral and parietal layers of the pericardium, thereby triggering chest pain. This condition is often accompanied by a pericardial friction rub, which can be felt by touching the precordial area.

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Written by Di Zhi Yong

Cardiology

45sec

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Why does pericardial effusion reduce the pulse pressure difference?

Pericardial effusion can result in reduced pulse pressure differences between systolic and diastolic pressures. This occurs because pericardial effusion can compromise the heart's pumping function, leading to decreased myocardial contractility, which in turn may lead to excessive vascular pressure and a decrease in pulse pressure. This is a pathological change caused by pericardial effusion. Currently, in treatment, medication can be chosen to improve patient's cardiac function and thereby increase cardiac output. It is also important to actively treat the pericardial effusion, which may involve pericardiocentesis to drain the fluid and check pressures, as this can also alleviate reduced pulse pressure issues.

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Written by Yuan Qing

Pulmonology

1min 3sec

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Can tuberculous pleurisy cause pericardial effusion?

Tuberculous pleurisy can also cause pericardial effusion. Firstly, tuberculous pleurisy is actually caused by the tubercle bacillus, a type of immune response in the human body that manifests as inflammation in the serous cavity. The serous cavities include various types such as the pleura surrounding the lungs, the pericardium around the heart, and the peritoneum in the abdomen. Therefore, tuberculous inflammation can occur in multiple serous cavities, including the pleura, pericardium, and abdominal cavity. Of course, when diagnosing, one cannot solely rely on the presence of effusion in multiple serous cavities to diagnose tuberculous pleurisy. Instead, it is essential to aspirate the pleural fluid and test certain markers in it, such as adenosine deaminase and lactate dehydrogenase. Most importantly, the presence of acid-fast bacilli in the fluid should be checked. If detected, it can generally be diagnosed as tuberculous.

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Written by Li Hai Wen

Cardiology

44sec

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Is pericardial effusion related to pneumonia?

Pericardial effusion is generally not closely related to pneumonia. The common causes of pericardial effusion mainly include tuberculous pericarditis, as well as factors such as tumors, heart failure, and hypoproteinemia. The onset of pulmonary inflammation primarily affects the lungs, with symptoms often manifesting as cough and yellowish sputum. Some patients may also experience pleural effusion. Pulmonary CT scans typically show inflammatory exudative changes. If the pericardial effusion is minor, it is usually not a significant issue, but proper medical examination is necessary to rule out causes like tuberculosis or tumors that could lead to pericardial effusion.

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Written by Di Zhi Yong

Cardiology

57sec

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Pericardial effusion usually requires attention to the following aspects:

If the patient has pericardial effusion, it is still necessary to maintain a light diet, eat small meals frequently, and especially avoid spicy and irritating foods. Meanwhile, patients should pay attention to regular re-examinations of cardiac echocardiography and electrocardiograms, as the most effective and direct method for diagnosing pericardial effusion is puncture and fluid extraction for examination. For minor amounts of pericardial effusion, it is recommended that patients first observe and use medication, which can also help alleviate symptoms. During this period, it is important to monitor changes in the patient's blood pressure and heart rate. If blood pressure rises or heart rate increases rapidly, it can exacerbate pericardial effusion. However, it is still crucial to actively use medication for early intervention, which can also help alleviate symptoms, and actively prevent upper respiratory infections.