cardiac tamponade

Question 1

what is cardiac tamponade

Answer 1

an accumulation of pericardial fluid which can impair cardiac output

Question 2

pathophysiology of cardiac tamponade

Answer 2

cardiac tmaponade occurs when a pericardial effusion raises intrapericardial pressure and reduces veentricular filling and cardiac output

Question 3

common causes of cardiac tamponade

Answer 3

pericarditis
trauma
lung/breast cancer
myocardial infacrt
rare: uremic pericarditis, radiation exposure, aortic dissection, autoimmune (scleroderma, SLE)

Question 4

presentation of cardiac tamponade

Answer 4

dyspnoea (due to decreased cardiac output)
chest pain
muffled heart sounds
signs of local compression (hiccups, nausea, bronchial breathing)

Question 5

beck’s triad

Answer 5

hypotension, elevated JVP, muffled. heart sounds

Question 6

diagnosis

Answer 6

clinical diagnosis in the acute setting, but is confirmed by haemodynamic improvement after pericardiocentesis

Question 7

bedisde and labs

Answer 7

ECG - may show tachycardia, low-voltage QRS and electrical alternans
FBC - white cells may be elevated in pericarditis
UEC - urea my be elevated in uraemic paricarditis
creatine kinase and cardic troponins - elevated in MI, cardiac trauma
coags - to establish bleeding risks for potential surgery

Question 8

imaging

Answer 8

echo - pericardial effusion
CXR - may see evidence of chest wall trauma, cardiomegaly

Question 9

other special tests

Answer 9

culture of pericardial fluid to assess for infection
cytology of pericardial fluid to assess for malignancy
pericardial biopsy if malignancy is suspected

Question 10

differentials

Answer 10

aortic dissection
MI
pulmonary embolism
tension pneumothorax
constrictive pericarditis
liver cirrhhosis

Question 11

haemodynamic support

Answer 11

can be initiated to stabilise the paatient while preparing for pericardial decompression
cautious fluid replacement in hypovolaemic patients, as excessive fluid will excacerbate tamponade
avoid inotropes, anaesthetic agents, and PPV as theese can worsen the patients haemodynamic state

Question 12

pericardiocentesis

Answer 12

a procedure in which a needle is percutaneously inserted into the pericardial space, allowing simple needle aspiration of pericardial fluid

Question 13

surgical drainage

Answer 13

drainage of peericardial fluid under GA

Question 14

when is surgical drainage used

Answer 14

for
haemopericardium
trauma
purulent effusion
requiring pericardial biopsy
reaccumulation of fluid after intial pericardiocentesis

Question 15

what is pericardial effusion

Answer 15

acute or chronic accumulation of fluid in the pericardial space

Question 16

hemopericardium

Answer 16

accumulation of blood in the pericardial space

Question 17

serous or serosanguinous pericardial effusion

Answer 17

idiopathic
acute pericarditis
malignancy
postpericardiotomy syndrome
uremia
aautoimmune disorders
hypothyroidism
right heart faailure

Question 18

symptoms of pericardial effusion

Answer 18

initially asymptomatic in most cases
SOB, especially when lying down - orthopnea
retrosternal chest pain
compressive symptoms
apical impulse is ddifficult to locate or non-palpable

Question 19

compressive symptoms

Answer 19

hoarseness: due to compression of the laryngeal nerve
nausea due to compression of the diaphragm
dysphagia due to compression of the oesophagus
hiccups: due to compression of the phrenic nerve

Question 20

diagnosis in stable patients

Answer 20

echocardiography for suspected pericardial effusion and/or tamponade

Question 21

electrical alternans

Answer 21

consecutive QRS complexes that alternate in height due to the swinging motion of the heart when surrrounded by large amounts of pericardial fluid

Question 22

pericardiotomy

Answer 22

the creation of an opening in the pericardium to allow continuous drainage of pericardial fluid

Question 23

pericardiectomy

Answer 23

performed as definitive management for refractory pericardial effusion