Cardiac Tamponade
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Cardiac Tamponade

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    Cardiac Tamponade Cardiac Tamponade Presentation Transcript

    • CARDIAC TAMPONADE Dr. Mansoor Khan MBBS, FCPS I, Resident, Surgical “C”, KTH Peshawar. Jan 5th, 2009
    • “ Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put ”
    •  
    • Pericardium typically has 20-50 ml of fluid
    • 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
      • Pericardial fluid > increase intrapericardial pressure
      • Intrapericardial pressure equalizes RV diastolic Pressure
      • Then equalizes LV diastoilic pressure
      • Drop in cardiac output
      Pathophysiology
    •  
    • Dyspnea, Chest pain, Abdominal pain, Fatigue, Fever, Cough, Weakness, Palpitation, Maybe in shock, thus not able to elicit symptoms S YMPTOMS
    • Beck’s Triad S I G N S Hypotension JVP Diminished heart sounds
    • 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
    • low voltage, sinus tach, PR depression, electrical alternans E K G
    • Enlarge cardiac silhouette, water bottle shaped heart C X R
        • Pericardial effusion, collapse of the right ventricular, Swinging of the heart in its sac
      ECHOCARDIOGRAM
    •  
        • In tamponade, near equalization (within 5 mm Hg) of the right atrial, right ventricular diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressure
      • 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
          • 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
    •  
    • THANKS