Pericardial Effusion in Pulmonary Embolism: A Sign of Right Ventricular Strain

Pathophysiology of Right Ventricular Strain in Pulmonary Embolism

The European Society of Cardiology recommends that in massive pulmonary embolism, the increase in right ventricular afterload leads to right ventricular dilation with increased myocardial work and oxygen consumption 1, 2
The European Heart Journal notes that restriction of the pericardium results from right ventricular dilation, contributing to decreased left ventricular output 1, 2
The American College of Cardiology states that septal displacement to the left compromises left ventricular filling 1, 2, 3
The European Society of Cardiology reports that there is a reduction in the cardiac index despite adequate blood pressure and constant preload 1, 2

The European Heart Journal recommends that echocardiographic criteria for right ventricular dysfunction in pulmonary embolism include right ventricular dilation with a right ventricle to left ventricle ratio >0.5 4
The American College of Cardiology notes that hypokinesis of the right ventricle with a characteristic regional pattern (preservation of the apex) is a sign of right ventricular strain 4
The European Society of Cardiology states that tricuspid regurgitation with a jet velocity >2.5-3.5 m/s is a criterion for right ventricular dysfunction 4
The European Heart Journal reports that dilation of the inferior vena cava without inspiratory collapse is a sign of right ventricular strain 4
The American College of Cardiology recommends that an altered flow pattern in the right ventricular outflow tract is a criterion for right ventricular dysfunction 4
The European Society of Cardiology notes that an acceleration time <60 ms with a trans-tricuspid gradient <60 mmHg (98% specific for acute pulmonary embolism) is a sign of right ventricular strain 4

The European Heart Journal states that in chronic pulmonary hypertension, pericardial effusion is associated with a prevalence of 25-30% 5
The American College of Cardiology notes that the pathophysiological mechanism of pericardial effusion in chronic pulmonary hypertension is chronic right ventricular failure with increased right-sided filling pressures, right atrial hypertension, and lymphatic obstruction 5
The European Society of Cardiology reports that even small pericardial effusions confer a poor prognosis in chronic pulmonary hypertension 5
The European Heart Journal recommends that pericardial effusion is a marker of comorbidity associated with connective tissue disease, reduced 6-minute walk distance, and elevated natriuretic peptide 5