Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Cardiac tamponade gk

3,652 views

Published on

Cardiac tamponade gk

  1. 1. Cardiac Tamponade 3 possible pericardial compression syndromes  Cardiac tamponade  accumulation of pericardial fluid under pressure and may be acute or subacute  Constrictive pericarditis  scarring and consequent loss of elasticity of the pericardial sac  Effusive-constrictive pericarditis  constrictive physiology with a coexisting pericardial effusion  Chicken or egg? Elevated wedge and Rt sided pressures s/p drainage
  2. 2. Cardiac Tamponade Compression of all cardiac chambers due to increased pericardial pressure Pericardium has some compliance with increased pressure, but once that is exceeded it begins to impair diastolic compliance, reducing cardiac filling Much of the pressure is transmitted to the Rt Vent/Atrium (lower pressure systems) which causes which causes bulging of interventricular septum and decreased Lt ventricular compliance and filling
  3. 3. Pericardial Effusion Pericardium typically has 20-50 ml of fluid Acuity of fluid accumulation plays a large role in pericardial compliance  Rapid accumulation (trauma) gives pericardium no time to adjust, therefore a small amount of fluid can cause tamponade  Slow accumulation allows pericardial compliance to increase allowing a larger volume of fluid into sac  However, when pericardial pressures > Rt ventricular pressure tamponade physiology can occur
  4. 4. Causes of Pericardial Tamponade Malignancy HIV infection 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 Radiation therapy Iatrogenic - After sternal biopsy, transvenous pacemaker lead implantation, pericardiocentesis, or central line insertion Uremia Idiopathic pericarditis Complication of surgery at the esophagogastric junction such as antireflux surgery Pneumopericardium (due to mechanical ventilation or gastropericardial fistula)
  5. 5. Symptoms Dyspnea, tachycardia, tachypnea Cold, clammy extremities Malignancy – weight loss, fatigue, anorexia Chest pain – pericarditis, MI Joint pain – connective tissue Renal failure – uremia Medications – drug related lupus Recent procedure – pacemaker, central line TB – night sweats, fever Radiation – cancer history
  6. 6. Physical Exam Findings Beck’s Triad – JVD, hypotension, 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 Abolished y descent
  7. 7. Diagnosis EKG – low voltage, sinus tach, PR depression, electrical alternans
  8. 8. Diagnosis CXR  enlarge cardiac silhouette, water bottle shaped heart
  9. 9. Diagnosis Echocardiogram (tamponade is clinical diagnosis)  Pericardial effusion  Early diastolic collapse of the right ventricular free wall  Late diastolic compression/collapse of the right atrium  Swinging of the heart in its sac  LV pseudohypertrophy
  10. 10. Diagnosis Rt Heart Catheterization  If patient is stable and diagnosis is in doubt can perform a Rt heart catheterization to measure Rt sided pressures  In tamponade, near equalization (within 5 mm Hg) of the right atrial, right ventricular diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressure  Rt atrial pressure tracings show abolished systolic y descent
  11. 11. Treatment 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)  Choose inotropes that do not increase systemic vascular resistance while increasing cardiac output.
  12. 12. Treatment Once CT Surgery or Cardiology arrives  Pericardiocentesis  can be fluoroscopically or TTE guided  Pericardial window  involves the surgical opening of a communication between the pericardial space and the intrapleural space Recurrent effusion  Pericardectomy  Pericardial-peritoneal shunt  Pericardiodesis - corticosteroids, tetracycline, or antineoplastic drugs can be instilled into the pericardial space sclerosing the pericardium
  13. 13. Treatment No one shows up and cardiac arrest is called  Emergency subxiphoid percutaneous drainage  A 16- or 18-gauge needle is inserted at an angle of 30-45° to the skin, near the left xiphocostal angle, aiming towards the left shoulder  When performed emergently, this procedure is associated with a reported mortality rate of approximately 4% and a complication rate of 17%

×