A Bloody Pericardial Effusion

Submitted by Dr T on July 3, 2015 – 9:04am

Question:

My father was recently hospitalized with a pericardial effusion and atrial fib/flutter with a rate of 160. Rate was decreased over 24 hours to 110-115 on amiodarone and diltiazem. His cardiologist wanted to perform a chemical stress test. (He had a negative cardiac cath 2 years prior). My father felt that he was unable to tolerate the test, so he requested to speak with the cardiologist (who never came back to seem him). Two days later, 750cc of bloody fluid was removed via pericardial centesis (needless to say by another cardiologist). My question is – Why would the cardiologist want to perform a chemical stress test on a patient who has a heart rate of at least 110 and who has 750cc of fluid around his heart? Would this not be detrimental to the patient and what was to be gained from performing this test when clearly CAD was not an issue and the pericardial effusion SHOULD have been priority?

Good question, so why don’t you ask that cardiologists? When the pericardium becomes inflamed, the amount of fluid between the heart and the pericardium increases. This squeezes the heart and restricts its action and in his case, may have caused the AF/Flutter.

Btw CAD has not been excluded and could yet be present, but I agree the focus should be on determining the cause of the pericardial effusion, which most likely will recur. Likewise the cause of AF hasn’t been examined (I’d guess the effusion). Further testing will be necessary and may well include a biopsy of his pericardium. In some cases most of the pericardium may need to be removed (pericardiectomy) to prevent further recurrences.

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Hope this helps,

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