Yr 2 CVS- Cardiac Tamponade

Question 1

What can cause an elvated JVP?

Answer 1

Right ventricular failure- cos backlog

Consitrictive pericarditis

Cardiac tamponade

Tension Pneumothorax

Pulmonary Embolism

SVC obstruction

Question 2

WHats the triad called that asses cardiac tamponade? Explain it

Answer 2

Beck triad is a collection of three clinical signs associated with pericardial tamponade which is due to an excessive accumulation of fluid within the pericardial sac.

The three signs are:

1. low blood pressure (weak pulse or narrow pulse pressure)
2. muffled heart sounds
3. raised jugular venous pressure

Question 3

Step by step to assess JVP

Answer 3

Question 4

What is pulses paradox and why is significant for cardiac tamponade?

Answer 4

Pulsus paradoxus is defined as a fall of systolic blood pressure of more than 10 mmHg during the inspiratory phase. Usually done manually

Cardiac tamponade causes pulsus paradoxus.

Question 5

Mechanism of pulsus paradoxes

Answer 5

During inspiration, the negative intra-thoracic pressure results in an increased right venous return, filling the right atrium more than during an exhalation. The increased blood volume dilates the right atrium, reducing the compliance of the left atrium due to their shared septum. Septum deviates more to the left causing less blood to fill in LV and so reduced SV and CO

Question 6

Cardiac Tamponade should be suspected in anyone with?

Answer 6

known pericarditis, pericardial effusion or chest trauma with key physical findings like:

• Jugular venous distention
• Systemic hyotension
• Distant heart sounds
• Sinu tachycardia
• pulsus paradoxus
• ECG findings

Question 7

What is a Swann Ganx catheter and what does it measure?

Answer 7

Swan-Ganz catheterization is the passing of a thin tube (catheter) with a balloon (wedge) in then end, into on of the Peripheral veins like (jugular, axillary) then through the right side of the heart and the arteries leading to the lungs. It is done to monitor the heart’s function and blood flow and pressures in and around the heart.

Measures left atrial pp and pulmonary ARTERY PRESSURE

Question 8

During insertion of the SG catheter the pressure is monitored at the tip. Would you be able to tell when the catheter has entered the right atrium? What would change when the tip is in the right ventricle?

Answer 8

In the right atrium, the pressure usually averages <5 mmHg and fluctuates a few mmHg. SYSTOLIC DECREASES

When the catheter is advanced into the right ventricle, the systolic pressure increases to ~25 mmHg and the diastolic pressure remains similar to right atrial diastolic pressure. SYSTOLIC INCREASE

When the catheter enters the pulmonary artery, the systolic pressure normally is similar to the right ventricular systolic pressure, but the diastolic pressure increases to about 10 mmHg because of pulmonic valve closure at the beginning of diastole. DIASTOLIC now increases too

Question 9

Investigations for Cardiac tamponade?

Answer 9

ECG

Echocardiogram

Blood test- to check BNP/ANP or elvated tropnin to see if there is heart failure

CTPA

D-dimer- - Blood D-dimer levels can be used to help diagnose thrombosis. D-dimer is a fibrin degradation product generated from blood clot degradation by fibrinolysis