Cardiac Tamponade Flashcards

1
Q

What is cardiac tamponade?

A
  • Accumulation of pericardial fluid, blood, pus or air within pericardial space
  • Creates intra-pericardial pressure
  • Restricts cardaic filling + reduces cardiac output
  • A cardiac emergency + fatal if not quickly diagnosed/treated
  • Diagnosis based upon clinical suspicion and supported by evidence of haemodynamic compromise on echo

DDx → constrictive pericarditis / restrictive cardiomyopathy / cardiogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for cardiac tamponade?

A
  • Malignancy → lung + breast
  • Aortic dissection → Type A
  • Purulent pericarditis → rare
  • Large idiopathic pericardial effusion
  • Iatrogenic related haemorrhage
  • TB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Tamponade occurs at any age but most common in middle-aged + older people. In people from endemic regions, TB pericarditis remains prominent cause of effusion and tamponade.

In symptomatic patients, what are the most common causes of tamponade?

A
  • Iatrogenic (post-cardiac surgery/intervention)
  • Trauma
  • Malignancy
  • Idiopathic effusion

Others → viral infection, radiation-induced pericarditis, collagen vascular disease, myxoedema, TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the clinical features of tamponade?

A
  • Beck’s triad → hypotension / raised JVP* / muffled heart sounds
  • Dyspnoea
  • Chest pain (atypical, non-exertional)
  • Abdo pain (2o hepatic congestion)

Other signs → tachycardia, pulsus paradoxus, electrical alternans (ECG)

*absent Y descent on JVP due to limited RV filling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the key differences between constrictive pericarditis and cardiac tamponade?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A pericardial effusion that raises intrapericardial pressure, reducing ventricular filling and thus dropping cardiac output can lead rapidly to cardiac arrest.

What is pulsus paradoxus and why does it occur?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which investigations can be done for cardiac tamponade?

A
  • ECG → electrical alternas
  • FBC → inflammatory pericarditis / anaemia in CKD
  • ESR → inflammatory marker
  • Cardiac enzymes → cardiac trauma / MI
  • CXR → ?enlarged cardiac silhouette
  • Transthoracic Echo (best) → invesrsion of the free wall of right atrium for over 1/3rd of systole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

With tamponade, there is a continuum of symptoms and haemodynamic effects. Pericardial effusions may resolve spontaneously or after treatment w/ NSAIDs or colchicine.

What is the management of a patient w/ haemodynamic instability?

A

Urgent pericardiocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly