CARDIAC TAMPONADE

Question 1

Definition and Clinical Features (4)

Answer 1

1- Rapid accumulation of fluid in the pericardial space in a rate that is fast enough to prevent the heart from compensating and stretching —> acute impairment of ventricular filling —> decreased stroke volume
2- Pulsus paradoxus: decrease in pulse (carotid/femoral) during inspiration and increase during expiration. (decrease <10mmHg of BP during inspiration)
3- Tachypnea, tachycardia, hypotension, elevated JVP, clear lungs
4- Beck’s triad: muffled heart sounds, jugular vein distension, hypotension

Question 2

Causes (3)

Answer 2

1- Penetrating trauma or iatrogenic: central line placement, pericardiocentesis
2- Pericarditis
3- Post MI

Question 3

Investigations (4)

Answer 3

1- Echo: most sensitive and specific noninvasive test. Shows right atrial and ventricular diastolic collapse. (compression of the chambers starts on the right side bc walls are thinner)
2- CXR: enlargement of cardiac silhouette
3- ECG: electrical alternans
4- Catheterization: equalization of pressure in all chambers in diastole

Question 4

Treatment (4)

Answer 4

1- If hemodynamically unstable —> pericardiocentesis
2- If hemorrhagic tamponade (penetrating trauma) —> emergent surgery
3- If patient is known to have renal failure and is hemodynamically stable —> dialysis
4- Do NOT use diuretics as they worsen the collapse