Br J Cardiol. Excessive fluid in the pericardial space is called pericardial effusion. Wilde AA, Antzelevitch C, Borggrefe M, Brugada J, Brugada R, Brugada P, Corrado D, Hauer RN, Kass RS, Nademanee K, Priori SG. Diseases of the pericardium present clinically in one of several ways: Acute and recurrent pericarditis Pericardial effusion without major hemodynamic compromise Cardiac tamponade Electrical alternans – i.e the beat-to-beat variation i electrical amplitude – is the ECG hallmark of cardiac tamponade. Atrioventricular Accessory Pathways: Mechanisms, Electrocardiograms, and Associated Arrhythmias. 2019 Jan 1;40(3):237-69. European heart journal. Pericardial effusion: The incidence is unknown. 1998 Feb 15;57(4):699. E-Journal or Cardiology Practice. Amal Mattu’s ECG Case of the Week – March 22, 2021. Congenital long QT syndrome. Diagnosis of Acute Pericarditis. What is the demarcation point between pleural from pericardial surface ? Biology open. 2002 Nov 5;106(19):2514-9. ECG changes are attributed to this. 1979 May;10(3):253-9. a series of tests to look for it, identify possible causes and determine treatment. The low specificity of a low-voltage ECG” was confirmed in 36 other patients with low voltage, among whom only 13 had pericardial effusion by echocardiographic findings. Keating L, Morris FP, Brady WJ. 2010;14(3):73. The Permanente journal. No ECG variable was sensitive for the detection of pericardial effusion. The most common cause of pericardial effusion is infections, such as viral, bacterial, and tuberculous infections. Pericardial effusions tend to cause ECG changes only when they are massive, and ECG changes are a poor indicator of pericardial effusions overall. Childers R. Teaching electrocardiogram interpretation. Ramires TG, Sant’Anna J, Pais J, Picarra BC. Electrocardiographic manifestations of hypothermia. Chest pain is often retrosternal in nature, pleuritic, and positional (relieved by sitting forward, worse lying flat) Postgraduate medical journal. Ishikawa K, Pipberger HV. 2018 Jun;34(3):312-4. 2008 Dec;3(1):18. de Winter RJ, Verouden NJ, Wellens HJ, Wilde AA. This dangerous problem causes a huge pressure on the heart and slows its ability to pump blood through the body. ECG manifestations: the poisoned patient. This allows the heart to move smoothly against other organs in the chest as it beats. ECG diagnosis: Hypothermia. Low voltage qrs. Zhang L, Liu L, R Kowey P, H Fontaine G. The electrocardiographic manifestations of arrhythmogenic right ventricular dysplasia. Journal of natural science, biology, and medicine. ECG Weekly; CME; ECGStat; Pricing; Weekly Cases; Group Purchase. Pericardial effusion is the accumulation of fluid in the pericardial space. Porela P, Kytö V, Nikus K, Eskola M, Airaksinen KE. History, exam, tests, drugs and interventions, ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------. The pericardial space (cavity) always contains a small amount of serous fluid which acts as a lubricant that prevents friction during ventricular contraction and relaxation. The ECG variables were independently measured by two investigators blinded to effusion status. Pericardial effusion is the buildup of extra fluid in the space around the heart. SEE FULL CASE. 2003 Sep 1;79(935):490-504. 2003 Sep 1;20(5):491-3. Significant pericardial effusion may bring about the following ECG changes. The classical ECG changes in pericardial effusion are sinus tachycardia, low QRS voltage and electrical alternans. The rate of fluid accumulation, and not necessarily the amount, is most important. Nishi SP, Barbagelata NA, Atar S, Birnbaum Y, Tuero E. Hypercalcemia-induced ST-segment elevation mimicking acute myocardial infarction. Classic teaching. Tachycardia. Levis JT. Inflammatory conditions, such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and rheumatic fever. While pericarditis can elevate the ST segment. Circulation: Arrhythmia and Electrophysiology. : Join our newsletter and get our free ECG Pocket Guide! Pericarditis is an inflammation of the lining surrounding the heart (the pericardial sac). Other frequent symptoms are pulsus paradoxus, pericardial friction sounds, tachycardia, tachypnea, weakened peripheral pulses, edema, cyanosis. 2008 Jul 1;51(1):1-22. Aortic dissection rupturing into the pericardium. Hollar L, Hartness O, Doering T. Recognizing Wellens’ syndrome, a warning sign of critical proximal LAD artery stenosis and impending anterior myocardial infarction. The ECG variables were independently measured by two in­ A fibrous sac called the pericardium surrounds the heart. Circulation. What are the ECG features of pleural effusion ? Clinical electrocardiography and ECG interpretation, Cardiac electrophysiology: action potential, automaticity and vectors, The ECG leads: electrodes, limb leads, chest (precordial) leads, 12-Lead ECG (EKG), The Cabrera format of the 12-lead ECG & lead –aVR instead of aVR, ECG interpretation: Characteristics of the normal ECG (P-wave, QRS complex, ST segment, T-wave), How to interpret the ECG / EKG: A systematic approach, Mechanisms of cardiac arrhythmias: from automaticity to re-entry (reentry), Aberrant ventricular conduction (aberrancy, aberration), Premature ventricular contractions (premature ventricular complex, premature ventricular beats), Premature atrial contraction (premature atrial beat / complex): ECG & clinical implications, Sinus rhythm: physiology, ECG criteria & clinical implications, Sinus arrhythmia (respiratory sinus arrhythmia), Sinus bradycardia: definitions, ECG, causes and management, Chronotropic incompetence (inability to increase heart rate), Sinoatrial arrest & sinoatrial pause (sinus pause / arrest), Sinoatrial block (SA block): ECG criteria, causes and clinical features, Sinus node dysfunction (SND) and sick sinus syndrome (SSS), Sinus tachycardia & Inappropriate sinus tachycardia, Atrial fibrillation: ECG, classification, causes, risk factors & management, Atrial flutter: classification, causes, ECG diagnosis & management, Ectopic atrial rhythm (EAT), atrial tachycardia (AT) & multifocal atrial tachycardia (MAT), Atrioventricular nodal reentry tachycardia (AVNRT): ECG features & management, Pre-excitation, Atrioventricular Reentrant (Reentry) Tachycardia (AVRT), Wolff-Parkinson-White (WPW syndrome), Junctional rhythm (escape rhythm) and junctional tachycardia, Ventricular rhythm and accelerated ventricular rhythm (idioventricular rhythm), Ventricular tachycardia (VT): ECG criteria, causes, classification, treatment (management), Longt QT interval, long QT syndrome (LQTS) & torsades de pointes, Ventricular fibrillation, pulseless electrical activity and sudden cardiac arrest, Pacemaker mediated tachycardia (PMT): ECG and management, Diagnosis and management of narrow and wide complex tachycardia, Introduction to Coronary Artery Disease (Ischemic Heart Disease) & Use of ECG, Classification of Acute Coronary Syndromes (ACS) & Acute Myocardial Infarction (AMI), Clinical application of ECG in chest pain & acute myocardial infarction, Diagnostic Criteria for Acute Myocardial Infarction: Cardiac troponins, ECG & Symptoms, Myocardial Ischemia & infarction: Reactions, ECG Changes & Symptoms, The left ventricle in myocardial ischemia and infarction, Factors that modify the natural course in acute myocardial infarction (AMI), ECG in myocardial ischemia: ischemic changes in the ST segment & T-wave, ST segment depression in myocardial ischemia and differential diagnoses, ST segment elevation in acute myocardial ischemia and differential diagnoses, ST elevation myocardial infarction (STEMI) without ST elevations on 12-lead ECG, T-waves in ischemia: hyperacute, inverted (negative), Wellen's sign & de Winter's sign, ECG signs of myocardial infarction: pathological Q-waves & pathological R-waves, Other ECG changes in ischemia and infarction, Supraventricular and intraventricular conduction defects in myocardial ischemia and infarction, ECG localization of myocardial infarction / ischemia and coronary artery occlusion (culprit), The ECG in assessment of myocardial reperfusion, Approach to patients with chest pain: differential diagnoses, management & ECG, Stable Coronary Artery Disease (Angina Pectoris): Diagnosis, Evaluation, Management, NSTEMI (Non ST Elevation Myocardial Infarction) & Unstable Angina: Diagnosis, Criteria, ECG, Management, STEMI (ST Elevation Myocardial Infarction): diagnosis, criteria, ECG & management, First-degree AV block (AV block I, AV block 1), Second-degree AV block: Mobitz type 1 (Wenckebach) & Mobitz type 2 block, Third-degree AV block (3rd degree AV block, AV block 3, AV block III), Management and treatment of AV block (atrioventricular blocks), Intraventricular conduction delay: bundle branch blocks & fascicular blocks, Right bundle branch block (RBBB): ECG, criteria, definitions, causes & treatment, Left bundle branch block (LBBB): ECG criteria, causes, management, Left bundle branch block (LBBB) in acute myocardial infarction: the Sgarbossa criteria, Fascicular block (hemiblock): left anterior & left posterior fascicular block on ECG, Nonspecific intraventricular conduction delay (defect), Atrial and ventricular enlargement: hypertrophy and dilatation on ECG, ECG in left ventricular hypertrophy (LVH): criteria and implications, Right ventricular hypertrophy (RVH): ECG criteria & clinical characteristics, Biventricular hypertrophy ECG and clinical characteristics, Left atrial enlargement (P mitrale) & right atrial enlargement (P pulmonale) on ECG, Digoxin - ECG changes, arrhythmias, conduction defects & treatment, ECG changes caused by antiarrhythmic drugs, beta blockers & calcium channel blockers, ECG changes due to electrolyte imbalance (disorder), ECG J wave syndromes: hypothermia, early repolarization, hypercalcemia & Brugada syndrome, Brugada syndrome: ECG, clinical features and management, Early repolarization pattern on ECG (early repolarization syndrome), Takotsubo cardiomyopathy (broken heart syndrome, stress induced cardiomyopathy), Pericarditis, myocarditis & perimyocarditis: ECG, criteria & treatment, Eletrical alternans: the ECG in pericardial effusion & cardiac tamponade, Exercise stress test (treadmill test, exercise ECG): Introduction, Exercise stress test (exercise ECG): Indications, Contraindications, Preparation, Exercise stress test (exercise ECG): protocols, evaluation & termination, Exercise stress testing in special patient populations, Exercise physiology: from normal response to myocardial ischemia & chest pain, Evaluation of exercise stress test: ECG, symptoms, blood pressure, heart rate, performance, Causes of pericardial effusion and cardiac tamponade, Hemodynamic effects of pericardial effusion and cardiac tamponade, ECG changes caused by pericardial effusion and cardiac tamponade. 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Jugular venous distention most common cause of pericardial effusion and cardiac tamponade are hypotension, muffled heart and... Only when they are massive, and not necessarily the amount, is most.! Pulses, edema, cyanosis signs and symptoms of pericardial fluid sufficient to impair filling..., the pericardial sac is suggestive of an ultrafiltrate of plasma fleeting and not necessarily the amount is! Any condition that affects the pericardium is a sac that surrounds the heart R Kowey P, H G..