Pericardial effusion and cardiac tamponade are conditions caused by an abnormal accumulation of fluid in the pericardial space. Cardiac tamponade occurs when excess fluid buildup leads to reduced ventricular filling and hemodynamic compromise. Symptoms include breathlessness, chest pain, and hypotension. Diagnosis is made through ECG, echocardiogram, and x-ray. Treatment depends on severity but may include medications, drainage of fluid via pericardiocentesis, or surgery. Cardiac tamponade requires urgent pericardiocentesis to drain fluid and prevent further hemodynamic compromise.
Cardiac tamponade
Synonyms Pericardial tamponade
Hemorragic effusion.jpg
A very large pericardial effusion resulting in tamponade as a result of bleeding from cancer as seen on ultrasound. Closed arrow - the heart; open arrow - the effusion
Specialty Cardiac surgery
Symptoms Shortness of breath, weakness, lightheadedness, cough[1]
Usual onset Rapid or more gradual[2]
Causes Cancer, kidney failure, chest trauma, pericarditis, tuberculosis[2][1]
Diagnostic method Symptoms and ultrasound of the heart[2]
Treatment Drainage (pericardiocentesis, pericardial window, pericardiectomy)[2]
Frequency 2 per 10,000 per year (US)[3]
Cardiac tamponade, also known as pericardial tamponade, is when fluid in the pericardium (the sac around the heart) builds up, resulting in compression of the heart.
Cardiac tamponade
Synonyms Pericardial tamponade
Hemorragic effusion.jpg
A very large pericardial effusion resulting in tamponade as a result of bleeding from cancer as seen on ultrasound. Closed arrow - the heart; open arrow - the effusion
Specialty Cardiac surgery
Symptoms Shortness of breath, weakness, lightheadedness, cough[1]
Usual onset Rapid or more gradual[2]
Causes Cancer, kidney failure, chest trauma, pericarditis, tuberculosis[2][1]
Diagnostic method Symptoms and ultrasound of the heart[2]
Treatment Drainage (pericardiocentesis, pericardial window, pericardiectomy)[2]
Frequency 2 per 10,000 per year (US)[3]
Cardiac tamponade, also known as pericardial tamponade, is when fluid in the pericardium (the sac around the heart) builds up, resulting in compression of the heart.
Cardiogenic shock is a rare condition .in this heart unable to pump an adequate amount of blood flow. types coronary cardiogenic shock and noncoronary cardiogenic shock.causes include any rupture of the in the ventricles .mi condition, any infectious condition,any medication that is a rare condition of the heart Are older
Have a history of heart failure or heart attack
Have blockages (coronary artery disease) in several of your heart's main arteries
Have diabetes or high blood pressure
Are female, Race or ethnicity
Cardiogenic shock signs and symptoms include:
Rapid breathing
Severe shortness of breath
Sudden, rapid heartbeat (tachycardia)
Loss of consciousness
Weak pulse
Low blood pressure (hypotension)
Sweating
Pale skin
Cold hands or feet
Urinating less than normal or not at all
treatment like emergency medication,dopamine ,doputamine ,adrenaline also given as a treatment to the patent. some other surgical procedure is there like cabg , heart transplantationmetc. preventionj oxf this avoid smoking,control alcohol,avoid stress etc
-
CONGESTIVE CARDIAC FAILURE
DEFINiTION- Congestive Cardiac Failure/Heart Failure(HF) is clinical syndrome caused by inability of the heart to pump sufficient blood to meet the metabolic needs of the body. HF can results from any disorders that reduces ventricular filling(diastolic dysfunction)myocardial contractility(systolic dysfunction)
CLASSIFICATION-
According to position
Backward Failure
Forward Failure
According to location
Left Ventricle Failure(aortic Failure)
Right Ventricle Failure(pulmonale Failure)
Biventricular Failure(total Failure)(4)(5)
CLINICAL MANESFESTATION-
Fatigue
Weakness
Shortness of Breath at rest and exertion
Cough and Wheezing
Fluid overload
Nocturia
Proxymal nocturnal dyspnea
Pulmonary edema
Mitral valve stenosis
Hypertropic cardiomayopathy
DIAGNOSIS-
Patient History 12.Acute Renal Injury
Physical Examination 13.Dilated cardiomayopathy
ECG-stress/rest 14.Pulse Oximetry
Doppler 2D 3D 15.ABG/VBG measurement
Cardiac Catheterization 16.TEE measurement
Chest Radiography 17.SPECT
Angiography 18.MRI-CT scan(7)
Blood Test
Fasting Lipid Profile(FLP)
Coronary Angiography
Myocardial Biopsy(7)
LAB FINDINGS-
BUN(Blood Urea Nitrogen) Test
Liver Function Test
Kidney Function Test
B-type Naturetic peptide Test(BNP)
TREATMENT-
1)SURGICAL TREATMENT-
Coronary Artery Bypass Graft surgery
Valve Surgery
Left Ventricular Reconstructions
Passive Cardiac Support
Artificial cardiac pacemakers
Cardiac Transplantations
Implantable Cardiovascular Defibrillator
Ventricular Assist devicesvad.jpg(2)(3)(4)(6)
PATIENT MEDICATION COUNSELLING-
Maintain Patient in high Fowler`s Position
Elevates extremities when patient is stress
Frequently Monitor vital signs
Monitor intake of salt and water
Restrict intake of fluid below 1.5 liters in a day
Teach patient and family about disease provide life style change therapy
Explain side effects of medince
Provide info for exertion of work so as not increase workload on heart (3)(6)(8)
Cardiogenic shock is a rare condition .in this heart unable to pump an adequate amount of blood flow. types coronary cardiogenic shock and noncoronary cardiogenic shock.causes include any rupture of the in the ventricles .mi condition, any infectious condition,any medication that is a rare condition of the heart Are older
Have a history of heart failure or heart attack
Have blockages (coronary artery disease) in several of your heart's main arteries
Have diabetes or high blood pressure
Are female, Race or ethnicity
Cardiogenic shock signs and symptoms include:
Rapid breathing
Severe shortness of breath
Sudden, rapid heartbeat (tachycardia)
Loss of consciousness
Weak pulse
Low blood pressure (hypotension)
Sweating
Pale skin
Cold hands or feet
Urinating less than normal or not at all
treatment like emergency medication,dopamine ,doputamine ,adrenaline also given as a treatment to the patent. some other surgical procedure is there like cabg , heart transplantationmetc. preventionj oxf this avoid smoking,control alcohol,avoid stress etc
-
CONGESTIVE CARDIAC FAILURE
DEFINiTION- Congestive Cardiac Failure/Heart Failure(HF) is clinical syndrome caused by inability of the heart to pump sufficient blood to meet the metabolic needs of the body. HF can results from any disorders that reduces ventricular filling(diastolic dysfunction)myocardial contractility(systolic dysfunction)
CLASSIFICATION-
According to position
Backward Failure
Forward Failure
According to location
Left Ventricle Failure(aortic Failure)
Right Ventricle Failure(pulmonale Failure)
Biventricular Failure(total Failure)(4)(5)
CLINICAL MANESFESTATION-
Fatigue
Weakness
Shortness of Breath at rest and exertion
Cough and Wheezing
Fluid overload
Nocturia
Proxymal nocturnal dyspnea
Pulmonary edema
Mitral valve stenosis
Hypertropic cardiomayopathy
DIAGNOSIS-
Patient History 12.Acute Renal Injury
Physical Examination 13.Dilated cardiomayopathy
ECG-stress/rest 14.Pulse Oximetry
Doppler 2D 3D 15.ABG/VBG measurement
Cardiac Catheterization 16.TEE measurement
Chest Radiography 17.SPECT
Angiography 18.MRI-CT scan(7)
Blood Test
Fasting Lipid Profile(FLP)
Coronary Angiography
Myocardial Biopsy(7)
LAB FINDINGS-
BUN(Blood Urea Nitrogen) Test
Liver Function Test
Kidney Function Test
B-type Naturetic peptide Test(BNP)
TREATMENT-
1)SURGICAL TREATMENT-
Coronary Artery Bypass Graft surgery
Valve Surgery
Left Ventricular Reconstructions
Passive Cardiac Support
Artificial cardiac pacemakers
Cardiac Transplantations
Implantable Cardiovascular Defibrillator
Ventricular Assist devicesvad.jpg(2)(3)(4)(6)
PATIENT MEDICATION COUNSELLING-
Maintain Patient in high Fowler`s Position
Elevates extremities when patient is stress
Frequently Monitor vital signs
Monitor intake of salt and water
Restrict intake of fluid below 1.5 liters in a day
Teach patient and family about disease provide life style change therapy
Explain side effects of medince
Provide info for exertion of work so as not increase workload on heart (3)(6)(8)
6. DEFINITION
PERICARDIAL EFFUSION
“an abnormal accumulation of fluid
in the pericardial cavity”
CARDIAC TAMPONADE
“clinical syndrome caused by accumulation of
fluid in the pericardial space,
resulting in reduced ventricular filling and
subsequent hemodynamic compromise”
7. PATHO-PHYSIOLOGY
↑ Pressure
pericardi on rt side
al fluid of heart
Pooling
of blood
↓Venous
in pulm
return
capillari
es
↓Stroke
volume, Cardiac
Arrest
↓CO
How much pericardial fluid is needed to
10. CLINICAL SYMPTOMS
• Breathles
sness
• Chest
pain,
• Abdomina
l pain,
• Fatigue,
• Fever,
• Cough,
• Palpitati
on,
• Maybe in
11. PHYSICAL EXAMINATION
• tachycardia,
• distant or muffled
heart sounds
• jugular vein
distension
• falling BP,
• paradoxical pulse
(a drop in inspiratory
BP by greater than 10
mmHg).
12. Beck's triad.(rapid accumulation of pericardial fluid)
1. Hypotension occurs because of decreased stroke volume
2. jugular-venous distension due to impaired venous return to the heart
3. muffled heart sounds due to fluid inside the pericardium
18. TREATMENT: PERICARDIAL EFFUSION
The mortality and
MEDICINE morbidity of
• NSAIDS/Aspirin : for most pericarditis effusion is
pericardial
• Colchicine: COPE trial dependent upon
etiology and comorbid
• Systemic steroids: causes recurrence ; only if unre
conditions
• Hemodynamic support : IVF, Inotropes
• Pus? – drain+ i.v. antibacterial therapy
• TB- ATT+ iv predni 1-2 mg/kg x 7 d
• Antineoplastic therapy
SURGERY (if S/S persist)
• Pericardial sclerosis (tetra , doxy ,cisplatin,5 –FU
• Sub-xiphoid pericardial window with pericardiost
• Thoracotomy: pleuro-pericardial window
• Video-assisted thoracic surgery
20. TREATMENT: PERICARDIAL EFFUSION
Pericardiocentesi
S/S s/
Sx Drainage
Known Treat the
cause cause
Asympt Asirin/
o NSAIDS
No role for elective pericardiocentesis in asymptomatic ,
unless for diagnosis or if pus / TB Diagnostic
pericardiocentesis
21. TREATMENT: PERICARDIAL EFFUSION
Large effusion x 3 months
Remove as much as possible
Elective
Idiopathic Recurrence
pericardioce ?
Chronic
ntesis
Repeat
Pericardie Recurrence
Pericardiocen
ctomy ?
tesis
22. TREATMENT: CARDIAC TAMPONADE
Cardiac tamponade is a medical emergency
Untreated, cardiac tamponade is rapidly
and universally fatal
Prompt diagnosis and treatment is the key.
• O2
• Volume expansion
• Bed rest
• Inotropic drugs
• Positive-pressure mechanical
ventilation should be avoided
• Pericardiocentesis:
• A Swan-Ganz catheter can be left in
place for continuous monitoring of
hemodynamics
27. PERICARDIOCENTESIS
AFTER CARE
1. Monitor vitals
2. Look out for complications
3. Repeat ECHO & CXR
4. If Pt still symptomatic then may require
placement of catheter in the pericardial
space or surgical creation of a
pericardial window
30. • Signs & symptoms and management of
TAKE HOME MESSAGE the rate of
pericardial effusion depends on
accumulation of effusion
• Elective pericardiocentesis is not warranted in
all pericardial effusions
• Cardiac tamponade is a medical emergency, and
if untreated, its rapidly and universally fatal
• Prompt diagnosis and treatment is the key.
• Pericardiocentesis is a life saving procedure in
tamponade
• Monitor vitals after the procedure to look for