Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 146

Small pericardial effusions (5–9 mm) are seen in 5% of STEMIs, usually appearing during the first 5 days and slowly resolving over several weeks.^165,166 A small pericardial effusion may be secondary to pericarditis or to pump failure and may be associated with an increase in long-term mortality. It is not usually associated with a free wall rupture unless it progresses to a moderate effusion, which happens in a minority of patients.¹⁶⁶ Echo surveillance is warranted even for a small effusion.

Moderate or large pericardial effusions (≥10 mm) were seen in 5% of STEMIs before the reperfusion era, and are probably less common in the PCI era. A moderate pericardial effusion, even if asymptomatic, is associated with an 8% risk of death from free wall rupture, which tends to occur over a week late. While it may result from pump failure or pericarditis in some patients, a moderate pericardial effusion represents a sealed, subacute myocardial rupture with self-limited bleeding in a substantial proportion of patients. A large effusion with tamponade or pulseless electrical activity is usually due to free wall rupture and warrants emergent surgical repair. A moderate effusion, if diagnosed on a pre-discharge echo or in a symptomatic patient, warrants at least more prolonged monitoring, close echo surveillance, and potentially a cardiac MRI to diagnose impending rupture. Anticoagulation should be discontinued.