Pericardial Tamponade & Pericardiocentesis Flashcards
3 Pericardial Compression Syndromes
Cardiac tamponade
Constrictive pericarditis
Effusive-constrictive percarditis
Define Cardiac Tamponade
Accumulation of pericardial fluid under pressure and may be acute or subacute
Define Constrictive Pericarditis
Scarring and consequent loss of elasticity of the pericardial sac
Define Effusive-Constrictive Pericarditis
Constrictive physiology with a coexisting pericardial effusion
How does cardiac tamponade effect cardiac output?
Increased pressure in the pericardium exceeds ventricular pressure impairing diastolic compliance reducing cardiac filling
Acute Pericardial Effusion
Pericardium has no time to adjust
Small volume of fluid can cause tamponade
Insidious Pericardial Effusion
Pericardial compliance increases allowing a larger volume of fluid into sac
Causes of Pericardial Tamponade
Malignancy HIV infection Infection Drugs Post-coronary intervention Trauma CV surgery Post-MI CT diseases Radiation therapy Iatrogenic Uremia Idiopathic pericarditis Complication of surgery at EJ junction Pneumopericardium
Define Uremia
High levels of urea in the blood from kidney failure
Symptoms of Pericardial Tamponade
Dyspnea Tachycardia Tachypnea Cold, clammy extremities Weight loss, fatigue, anorexia Chest pain Joint pain Renal failure Medications Recent procedure TB Radiation
Beck’s Traid
Increased JVP
Hypotension
Diminished heart sounds
Physical Exam Findings
Beck's Triad Hepatomegaly Evidence of chest wall trauma Pulsus paradoxsus Kussmaul sign Abolished y descent
Diagnostics of Pericardial Tamponade
EKG: electrical alternans, ST
CXR: enlarged cardiac silhouette
Echo: effusion, diastolic collapse, LV pseudohypertrophy
Right heart cath: measure right sided pressures
Treatment of Cardiac Tamponade
Surgery: pericardiocentesis or pericardial window Oxygen Volume expansion Bed rest with leg elevation Inotropic drugs
Describe a Pericardial Window
Surgical opening of a communication between the pericardial space and the intracellular space
