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Cardiac Tamponade
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Cardiac Tamponade

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