Pericardial Decompression Syndrome

This infographic explains Pericardial Decompression Syndrome (PDS), a rare but serious complication following pericardiocentesis. It highlights the pathophysiology, clinical presentation, risk factors, and management strategies for this syndrome, emphasizing careful monitoring after fluid removal.

1. Definition

• PDS is a paradoxical worsening of hemodynamics and cardiac function following the drainage of pericardial fluid, leading to pulmonary edema and low cardiac output. It typically occurs in patients with large pericardial effusions or cardiac tamponade.

2. Pathophysiology

• Interventricular Independence: After rapid pericardial fluid removal, the previously compressed right ventricle expands, shifting the septum toward the left ventricle and reducing left ventricular filling. This can result in acute heart failure and pulmonary edema.
• Ischemia: Temporary coronary artery compression may lead to myocardial ischemia and stunning, causing diastolic dysfunction.
• Autonomic Imbalance: A sudden withdrawal of the autonomic stimulus after drainage can also contribute to hemodynamic instability.

3. Risk Factors

• Malignancy
• Large-volume effusions
• Reduced ejection fraction (EF)
• Prior radiotherapy
• Pericardial calcification or connective tissue disorders

4. Recommendations

• Avoid rapid drainage: No more than 1L pericardial fluid at a time; decompression has been reported with as little as 450 cc.
• Prolonged drainage is preferred to avoid hemodynamic instability.
• Monitor patients carefully until symptoms and hemodynamics stabilize.

5. Treatment

• Supportive care: Patients often recover spontaneously.
• Close monitoring in an ICU setting for the first 24 hours.
• In severe cases, vasopressors, inotropic support, diuretics, or mechanical support with intra-aortic balloon pumps or impella devices may be needed.

Created by Dr. Chelsea Amo-Tweneboah
Reviewed by Dr. Rawan Amir, Dr. Amit Goyal, Dr. Karla Asturias

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