Tamponade Flashcards
What happens to JVP waveform w/ tamponade?
Lose “Y” descent (RV filling loss)
Becks triad consist of?
D- Distended JVP
D- Distant Heart sounds
D- Decreased BP
What pulse is associated w/ tamponade?
Pulsus paradoxus
What is pulsus paradoxus?
> 10mmHG drop of SBP during NL inspiration
What can you expect on a EKG of tamponade or a very LRG effusion?
Electrical alternans
Low voltage
Electrical alternas is due to
Heart swinging back and forth beat to beat
Closer to chest then away
Why is echo beneficial for tamponade?
Can visualize cardiac chamber compression
What are inflammatory signs associated with pericarditis?
Pleuritic chest pain
Friction Rub
Fever +/-
Diffuse ST elevation
Tamponade + inflammatory signs is?
DX of acute idiopathic pericarditis
Large effusion w/ no inflammatory S/S or tamponade is?
Chronic idiopathic pericardial effusion
Tamponade w/out inflammatory S/S is?
Malignant effusion
DX tests/eval of tamponade include
Cardiac cath + same Dx tests as pericardial effusion
What is the benefit of performing a cardiac cath on a pt w/ tamponade?
Can directly measure intercardial/pericardial pressures
Causes of Exudates? M-PIC
M- Malignancy
P- Post-pericardiotomy
I- Infection
C- Collagen vascular DZ
Causes of transudate? HURT
H- Hypothyroidism
U- Uremia
R- Radiation
T- Trauma
Most important TXT of tamponade is? (2)
TXT underlying cause
Aggressive fluid management
What is pericariotomy?
Balloon used to create window for drainage
Difference between Tamponade and Constrictive PC?
Tamponade - Fluid under pressure
Constrictive PC - Scarred/rigid pericardium
What happens with impaired diastolic filling?
Elevated venous pressures > systemic & plum congestion
Impaired SV > Decreased CO
What are some common S/S between Tamponade and constrictive PC? “DR. PATHH”
D - Distended JVP R - Rales P - Peripheral Edema A - Ascites T - Tachycardia H - HOTN H - Hepatomegaly
What are the chronic inflammatory changes that happen w/ constrictive PC?
F- Fibrosis
A- Adherence
T- Thickening
C- Calcification
What does constrictive PC mimic?
R sided heart failure
What does constrictive PC essentially do to the heart filling?
Impairs diastolic filling WITHOUT effecting systolic filling
What are RHF S/S?
Increased Systemic venous pressure
Ascites
Hepatospleomegaly
Peripheral edema
Decreased CO leads to?
Dyspnea
Fatigue
HOTN
Tachycardia
What are 3 unique findings w/ someone who has constrictive PC?
Precording knock
Kussmauls
Cachexia
When is the precordial knock?
Early diastolic - Slightly before S3 murmur found in constrictive PC
What can you expect to see on an EKG of constrictive PC?
Non-specific ST & T wave changes
Tachycardia
Low voltage
A-fib
What are the benefits of an ECHO TTE w/ constricitive PC?
Diagnostic
Can locate septal bounce
Measure thickening
What is a septal bounce?
It is intraventricular septal changes w/ respiration found in constrictive pericarditis
What unique test can you use when DX constrictive PC?
CMR
Why is CMR a useful test when DX constricitive PC?
Can differentiate pericardial thickening from SML effusion or prep a pericardiectomy candidate
What is the only effective TXT of constrictive PC?
Pericardiectomy (S/S doesnt resolve immediately)
What determines the outcome of pericardiectomy?
Depends on LV dysfx, (1 in 5 die - 20%)
What does an impaired LV lead to?
Decreased SV, CO, and tachycardia
What is MC cause of constrictive PC?
Idiopathic/viral
What pericarditis does constrictive PC rarely follow?
Acute PC
