presentation for medical students

1. HRISTO RAHMAN 03/04/20
PERICARDIAL
TAMPONADE
DEPARTMENT OF CARDIAC AND VASCULAR
SURGERY
MEDICAL UNIVERSITY PLOVDIV

2. HRISTO RAHMAN 03/04/20
• HAEMODYNAMIC COMPROMISE WITH ACUTE DYSPNOEA AND TACHYPNOEA
• LOW PULSE VOLUME WITH PULSUS PARADOXUS
• LOW OR UNDETECTABLE BLOOD PRESSURE
• RAISED JUGULAR VENOUS PULSE ( JVP ) WITH PROMINENT X DESCENT BUT NO Y
DESCENT
• KUSSMAUL’S SIGN ( INSPIRATORY RISE OF JVP ) IS NOT COMMON
• MUFFLED HEART SOUNDS
• OLIGURIA OR ANURIA
PERICARDIAL TAMPONADE:
CLINICAL FEATURES

3. BECK TRIAD

4. HRISTO RAHMAN 03/04/20
• DEFINED AS ABNORMALLY EXCESSIVE FALL IN SYSTOLIC BLOOD PRESSURE ON INSPIRATION
>10 MMHG
• NORMALLY ON INSPIRATION THERE IS SLIGHT FALL IN SYSTOLIC BLOOD PRESSURE ( < 5 MMHG
)
• IN CARDIAC TAMPONADE, INCREASED VENOUS RETURN OCCURING ON INSPIRATION CAUSES
FILLING OF RIGHT HEART , THEREBY DISPLACING INTERVENTRICULAR SEPTUM TO THE LEFT (
RIGID BOX WITH TAMPONADE ), RESULTING IN LESS FILLING POSSIBLE IN THE LEFT HEART
PRODUCING REDUCED CARDIAC OUTPUT AND SYSTEMIC BLOOD PRESSURE
• OTHER CAUSES OF PULSUS PARADOXUS INCLUDE:
• -1. CONSTRICTIVE PERICARDITIS;
• -2. STATUS ASTHMATICUS
WHAT IS PULSUS PARADOXUS
?

7. HRISTO RAHMAN 03/04/20
• ECG:
• - LOW VOLTAGE QRS COMPLEXES, ELECTRIC ALTERNANS ( DUE TO HEART MOVING WITHIN FLUID-FILLED SAC )
• CXR:
• - SYMMETRICAL GLOBULAR ENLARGEMENT OF THE HEART
• ECHOCARDIOGRAPHY:
• - LARGE PERICARDIAL COLLECTION;
• - HEART SWINGING FREELY WITHIN PERICARDIAL SAC;
• - EARLY DISTOLIC COLLAPSE OF RIGHT VENTRICLE;
• - LATE DIASTOLIC COLLAPSE OF RIGHT ATRIUM;
• - MARKED RESPIRATORY TRICUSPID VALVE (>40%) AND MITRAL VALVE (>25%) INFLOW VARIATION
TYPICAL FINDINGS ON INVESTIGATIONS WITH
PERICARDIAL TAMPONADE

8. HRISTO RAHMAN 03/04/20
• DEPENDING ON STABILITY OF THE PATIENT AND UNDERLYING CAUSE:
• PARAXIPHOID PERICARDIOCENTHESIS;
• SUBXIPHOID DRAINAGE OF PERICARDIAL COLLECTION;
• ANTEROLATERAL ( LEFT OR RIGHT ) THORACOTOMY DRAINAGE OF PERICARDIAL COLLECTION WITH PERICARDIAL
WINDOW;
• RE-OPENING OF MEDIAN STERNOTOMY
• OTHER ( CARDIAC TRAUMA )
TREATMENT OF PERICARDIAL
TAMPONADE

9. VS
PERICARDIOCENTHESIS PERICARDIAL WINDOW