Pericardial Tamponade and Constriction Flashcards
presentation of pts w/ chronic cardiac tamponade
- dyspnea
- fatigue
- peripheral edema
- hepatomegaly
- hepatic dysfunction
- ascites withOUT pulmonary congestion
dx for chronic cardiac tamponade may be suggested by risk factors for tamponade, which are?
- metastatic LUNG and BREAST cancers (MCC)
- recent cardiac surgery
- dissecting aneurysm
- recent viral or bacterial pericarditis
- systemic rheumatic disease
PE findings for chronic cardiac tamponade
- JVD
- pulsus paradoxus
- tachycardia
- reduced heart sounds
- hypotension
- Kussmaul sign (CVP increases w/ inspiration)
CXR finding for chronic cardiac tamponade
enlarged silhouette (“water bottle sign”)
test to confirm
echocardiogram
what virtually EXCLUDES a dx of cardiac tamponade?
pericardial effusion
thickened, fibrotic, and adherent pericardium that strains ventricular diastolic expansion, leading to impaired filling
constrictive pericarditis
often a sequela of acute pericarditis
constrictive pericarditis
cardiac auscultatory exam of constrictive pericarditis
- loud S3 (pericardial knock)
- friction rub
long-standing constrictive pericarditis may be a/w
liver failure and cirrhosis
imaging findings supporting dx of constrictive pericarditis
- calcified pericardium on XR (specific, but not sensitive)
- pericardial thickening on CT or MRI
- abnormal diastolic motion on echo
acute management of cardiac tamponade
- volume resuscitation
- vasopressors
tx for pericardial fluid
percutaneous pericardiocentesis or surgery
what meds should be avoided in chronic constrictive pericarditis?
diuretics, avoid if possible
most effective tx for chronic constrictive pericarditis
pericardiectomy
when is pericardiectomy unnecessary, and when is it unwarranted?
- unnecessary in pts w/ early dz (NYHA functional class 1)
- unwarranted in pts w/ advanced dz (NYHA functional class 4)
DON’T BE TRICKED
in CONSTRICTIVE PERICARDITIS echo will show shifting of ventricular septum to and fro during diastole as a manifestation of the RV and LV competing for a confined space during filling; these findings are NOT seen in what dz?
RCM
constrictive pericarditis vs restrictive CM:
- constrictive pericarditis
- PE: pericardial knock
supports dx
constrictive pericarditis vs restrictive CM:
- constrictive pericarditis
- PE: S3
may be present
constrictive pericarditis vs restrictive CM:
- constrictive pericarditis
- ECG: LBBB or RBBB
not helpful
constrictive pericarditis vs restrictive CM:
- constrictive pericarditis
- CXR: pericardial calcification
may be present
constrictive pericarditis vs restrictive CM:
- constrictive pericarditis
- echo: LVH and atrial enlargement
absent
constrictive pericarditis vs restrictive CM:
- RCM
- PE: pericardial knock
unusual but loud S3 may be mistaken for pericardial knock
constrictive pericarditis vs restrictive CM:
- RCM
- PE: S3
supports dx
