Cardiac Tamponade

10,865 views

Published on

Published in: Health & Medicine
1 Comment
13 Likes
Statistics
Notes
No Downloads
Views
Total views
10,865
On SlideShare
0
From Embeds
0
Number of Embeds
14
Actions
Shares
0
Downloads
740
Comments
1
Likes
13
Embeds 0
No embeds

No notes for slide

Cardiac Tamponade

  1. 1. CARDIAC TAMPONADE Dr. Mansoor Khan MBBS, FCPS I, Resident, Surgical “C”, KTH Peshawar. Jan 5th, 2009
  2. 2. “ Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put ”
  3. 4. Pericardium typically has 20-50 ml of fluid
  4. 5. Causes of Pericardial Tamponade <ul><li>Malignancy </li></ul><ul><li>Infection - Viral, bacterial (tuberculosis), fungal </li></ul><ul><li>Drugs - Hydralazine, procainamide, isoniazid, minoxidil </li></ul><ul><li>Postcoronary intervention (ie, coronary dissection and perforation) </li></ul><ul><li>Trauma </li></ul><ul><li>Cardiovascular surgery (postoperative pericarditis) </li></ul><ul><li>Postmyocardial infarction (free wall ventricular rupture, Dressler syndrome) </li></ul><ul><li>Connective tissue diseases - Systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis </li></ul><ul><li>Iatrogenic - After sternal biopsy, transvenous pacemaker lead implantation, pericardiocentesis, or central line insertion </li></ul><ul><li>Uremia </li></ul>
  5. 6. <ul><li>Pericardial fluid > increase intrapericardial pressure </li></ul><ul><li>Intrapericardial pressure equalizes RV diastolic Pressure </li></ul><ul><li>Then equalizes LV diastoilic pressure </li></ul><ul><li>Drop in cardiac output </li></ul>Pathophysiology
  6. 8. Dyspnea, Chest pain, Abdominal pain, Fatigue, Fever, Cough, Weakness, Palpitation, Maybe in shock, thus not able to elicit symptoms S YMPTOMS
  7. 9. Beck’s Triad S I G N S Hypotension JVP Diminished heart sounds
  8. 10. Hepatomegaly Evidence of chest wall trauma Pulsus paradoxsus > 12 mm Hg Kussmaul sign - paradoxical increase in venous distention and pressure during inspiration S I G N S
  9. 11. low voltage, sinus tach, PR depression, electrical alternans E K G
  10. 12. Enlarge cardiac silhouette, water bottle shaped heart C X R
  11. 13. <ul><ul><li>Pericardial effusion, collapse of the right ventricular, Swinging of the heart in its sac </li></ul></ul>ECHOCARDIOGRAM
  12. 15. <ul><ul><li>In tamponade, near equalization (within 5 mm Hg) of the right atrial, right ventricular diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressure </li></ul></ul>
  13. 16. <ul><li>What to do while your waiting on CT Surgery… </li></ul><ul><ul><li>Oxygen </li></ul></ul><ul><ul><li>Volume expansion with blood, plasma, or saline to maintain adequate intravascular volume </li></ul></ul><ul><ul><li>Bed rest with leg elevation </li></ul></ul><ul><ul><ul><li>This may help increase venous return. </li></ul></ul></ul><ul><ul><li>Inotropic drugs (i.e. dobutamine) </li></ul></ul>TREATMENT
  14. 17. <ul><ul><ul><li>A 16- or 18-gauge needle, angle of </li></ul></ul></ul><ul><ul><ul><li>30-45° to the skin, near the left xiphocostal angle, aiming </li></ul></ul></ul><ul><ul><ul><li>towards the left shoulder </li></ul></ul></ul><ul><ul><ul><li>Mortality rate of approximately 4%, complication rate of 17% </li></ul></ul></ul><ul><ul><li>Emergency subxiphoid </li></ul></ul><ul><ul><li>percutaneous drainage </li></ul></ul>
  15. 19. THANKS

×