Cardiac tamponade Flashcards
What is it?
Fluid within the pericardial space raising the intra-pericardial pressure
What effect does the raised into-pericardial pressure have?
Decreases cardiac output
What is the immediate measure upon suspicion in A and E?
Echocardiograph
Beck classic triad:
Hypotension
Distant heart sounds
Elevated JVP
Pain?
Atypical non-exertional chest pain
Abdominal pain due to hepatic congestion
Why is cancer history significant?
Could be secondary to therapy or metastatic
Symptom in 90% of patients?
Dyspnoea
What causes of tamponade will not also produce a tachycardia?
Uraemic pericarditis
Hypothyroidism
Echo signs of tamponade?
Right atrial systolic collapse
Right ventricular diastolic collapse
Respiratory variation in ventricle filling
Inferior vena cava plethora
Differential for constrictive pericarditis and restrictive cardiomyopathy?
Those have Kussmaul’s sign which is absent in tamponade
What is pluses paradoxus?
Drop in blood pressure during inspiration
Normal < 10 mmHg
Abnormal > 10 mmHg
Treatment for haemodynamically stable, small effusion, BP > 110, pulsus paradoxus < 10 mmHg that has been ongoing for months?
Anti-inflammatory medications (ibuprofen/aspirin/colchicine), gastro-protection (omeprazole) and observation
Treatment for haemodynamically unstable, BP < 110, pulsus paradoxus > 10, ongoing < 1 month?
Pericardiocentesis
Treatment for haemopericardium, trauma, purulent effusion or neoplastic disease?
Surgical drainage
What are the contraindications for pericardiocentesis?
Aortic dissection, major coagulopathy
