Cardiac Tamponade Flashcards
1
Q
ESSENCE
A
- Accumulation of fluid in pericardial sac
2
Q
AETIOLOGY
A
- Pericardial effusion
- Haemorrhage into pericardial sac
- Iatrogenic
3
Q
AETIOLOGY
Risk factors
A
- Pericarditis
- Malignancy
- Uremia
- SLE
- Tuberculosis
- Penetrating trauma
4
Q
PATHOANATOMY
A
- Pericardium is elastic sac that can stretch to accommodate normal cardiac volume expansion
- But if stretched beyond normal physiological expansion the pericardium will stiffen
5
Q
PATHOGENESIS
A
- Increased pericardial pressure from fluid accumulation causes compression of cardiac chambers
- Resulting in decreased cardiac output and BP
6
Q
PROGNOSIS
General
A
- Is medical emergency and can be fatal if not treated promptly
- In acute cases can develop quickly
- In chronic cases will develop gradually and pericardium can adjust slowly to increased pressure over time
7
Q
CLINICAL FEATURES
Presentation
A
- Chest pain
- Fatigue
- Often unresponsive to fluid resuscitation
8
Q
CLINICAL FEATURES
Signs
A
- Beck triad
- Cardiac - increased HR, pericardial rub
- Pulse parodoxus - decrease in BP
- Pulmonary - shortness of breath, lungs typically clear
- Extremities - cold and clammy, peripheral cyanosis
9
Q
What investigation is diagnostic
A
ECHO
10
Q
INVESTIGATIONS
A
- ECHO - make diagnosis
- Xray
- ECG
*
11
Q
ECHO findings
A
- Diastolic collapse of right heart
- Fluid in pericardial space
- Swinging of heart within effusion
12
Q
Xray findings
A
- Enlarged cardiac silhouette only seen in subacute cases
- In acute cases does not appear enlarged as pericardium not accomodated build up of >200cc fluid needed to appear enlarged
13
Q
ECG findings
A
- Variations in height of QRS complex
- Due to swinging of heart in chest
14
Q
DIFFERENTIALS
A
- Constrictive pericarditis
- Tension pneumothorax
- Pericardial effusion
15
Q
Constrictive pericarditis differentiate
A
Also has pulses paradoxus but also presents with Kussmaul sign and pericardial knock
16
Q
Tension pneumothorax differentiate
A
- Decreased or absent breath sounds
- Hyperresonant percussion
17
Q
Pericardial effusion differentiate
A
Similar but with stable vitals
18
Q
MANAGEMENT
General principles
A
- Choice depends on if patient haemodynamically stable or not
- Conservative
- Close monitoring and volume expansion
- Procedural
- Percutaneous pericardiocentesis
- Operative
- Surgical drainage
- Surgical drainage with pericardial window placement
19
Q
MANAGEMENT
Lines if haemodynamically stable
A
- 1) Anti-inflammatory plus gastroprotection plus observation
- Ibuprofen or aspirin or colchicine AND omeprazole
20
Q
MANAGEMENT
Lines if haemodynamically unstable
A
- 1) Pericardiocentesis
- 2) Surgical drainage
- If coagulopathy, neoplastic, trauma or purulent pericarditis
- 3) Surgical drainage and placement window
- If chronic
21
Q
COMPLICATION
Key one
A
Death
