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Flashcards in Pericardial Tamponade Deck (6)
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1
Q

What are the types of pericardial compression syndromes?

Describe each.

A

Cardiac tamponade: accumulation of pericardial fluid under pressure.

Constrictive Pericarditis: scarring and consequent loss of elasticity of pericardial sac. May be caused post-operatively.

Effusive-constrictive pericarditis: constriction d/t the thickening of the pericardium itself.

2
Q

Cardiac Tamponade:

-consequences on heart function.

A

Consequences:

  • compression of all cardiac chambers d/t increased pericardial pressure.
  • impaired diastolic compliance reducing cardiac filling
  • pressure is transmitted to the right ventricle and atrium which causes bulging of interventricular septum and decreased left ventricular compliance and filling.
3
Q

Pericardial Effusion:

  • how much fluid is usually in the pericardial sac?
  • what are the effects of acute/rapid accumulation of fluid within the pericardial sac? Chronic/slow accumulation?
A

20-50ml of fluid

Acute/rapid accumulation of fluid gives pericardium no time to adjust, small amount of fluid can cause tamponade.

Chronic/slow accumulation allos for pericardial compliance to increase allowing a larger volume of fluid into the sac.

4
Q

Pericardial Tamponade:

  • causes
  • sx
A

Causes:

  • malignancy
  • infection (viral, bacterial(TB), fungal)
  • CV surgery
  • Uremia
  • SLE, RA, dermatomyositis

Sx:

  • dyspnea, tachycardia, tachypnea
  • cold, clammy, extremities
  • Malignancy = weight loss, fatigue, anorexia
  • MI/pericarditisi = chest pain
  • CT = joint pain
  • Uremia = renal failure
  • Medications = drug related lupus
  • TB = night sweats, fever
5
Q

Pericardial Tamponade:

  • PE findings
  • EKG findings
  • CXR findings
A

PE:

  • becks triad = increased JVP, hypotension, diminished heart sounds.
  • hepatomegaly
  • chest wall trauma possibly
  • pulsus paradoxxsus (abnormally large decrease in SBP producing a weaker pulse during inspiration; greater than 12mmHg)
  • Kussmaul sign (paradoxical increase in venous distension and pressure during inspiration)

EKG findings:

  • low voltage
  • sinus tachy
  • PR depression
  • electrical alternans.

CXR: water bottle sign

6
Q

Pericardial Tamponade:

  • Dx
  • Tx
A
Dx: 
-clinical 
-get an echo
--pericardial effusion 
--diastolic collapse of right ventricular free wall 
--late diastolic collapse of right atrium 
-swinging of heart in sac?
-LV 
pseudohypertrophy 

-Right heart cath; will find near equilization of the right atrial, right ventricular diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressure

Tx:

  • Surgery, but while you wait…
  • -o2
  • -volume expansion with blood, plasma, or saline
  • -bed rest with leg elevation
  • -inotropic drugs (dobutamine)
  • Surgery: pericardiocentesis (fluoroscopically or TTE guided) or pericardial window
  • -can be done blind in emergent situation; below xiphoid process, aim towards left shoulder.

-if recurrent: pericardiectomy, pericardial-peritoneal shunt, pericardiodesis (steroids, tetracycline, or antineoplastic drugs instilled into the pericardial space