Pericardial effusion and tamponade: Difference between revisions
| Line 35: | Line 35: | ||
==Diagnosis== | ==Diagnosis== | ||
#[[Ultrasound: Cardiac|Ultrasound]] | #[[Ultrasound: Cardiac|Ultrasound]] | ||
## Pericardial effusion | |||
##RV diastolic collapse, effusion, there is often RA systolic and diastolic collapse seen also | ##RV diastolic collapse, effusion, there is often RA systolic and diastolic collapse seen also | ||
##5% false negative (usually b/c pericardium is decompressing into L chest) | ##5% false negative (usually b/c pericardium is decompressing into L chest) | ||
###Be suspicious if pt has a left-sided pulmonary effusion | ###Be suspicious if pt has a left-sided pulmonary effusion | ||
## Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variablility of transvalvular flow, this is due to the phenomenon of ventricular interdependence | |||
#ECG | #ECG | ||
##Tachycardia (bradycardia is ominous finding) | ##Tachycardia (bradycardia is ominous finding) | ||
Revision as of 01:03, 8 February 2015
Background
- Always consider in pt w/ PEA
- Always consider in pt w/ myocardial stab wound (80% result in tamponade)
- GSW is less likely to result in tamponade b/c pericardial defect is larger
- Pathophysiology
- Increased pericardial pressure > decreased RV filling > decreased CO
Etiology
- Hemopericardium
- Trauma
- Iatrogenic (misplaced central line)
- Bleeding diathesis
- Ventricular rupture (post-MI)
- Non-hemopericardium
- Cancer
- Pericarditis
- Infectious
- Uremic (renal failure)
- HIV complications (infection, Kaposi sarcoma, lymphoma)
- SLE
- Post-radiation
- Myxedema
Differential Diagnosis
Chest pain
Critical
- Acute coronary syndromes (ACS)
- Aortic dissection
- Cardiac tamponade
- Coronary artery dissection
- Esophageal perforation (Boerhhaave's syndrome)
- Pulmonary embolism
- Tension pneumothorax
Emergent
- Cholecystitis
- Cocaine-associated chest pain
- Mediastinitis
- Myocardial rupture
- Myocarditis
- Pancreatitis
- Pericarditis
- Pneumothorax
Nonemergent
- Aortic stenosis
- Arthritis
- Asthma exacerbation
- Biliary colic
- Costochondritis
- Esophageal spasm
- Gastroesophageal reflux disease
- Herpes zoster / Postherpetic Neuralgia
- Hypertrophic cardiomyopathy
- Hyperventilation
- Mitral valve prolapse
- Panic attack
- Peptic ulcer disease
- Pleuritis
- Pneumomediastinum
- Pneumonia
- Rib fracture
- Stable angina
- Thoracic outlet syndrome
- Valvular heart disease
- Muscle sprain
- Psychologic / Somatic Chest Pain
- Spinal Root Compression
- Tumor
Clinical Features
- CP, SOB, fatigue
- CHF-type appearance
- Narrow pulse pressure
- Friction rub
- Beck's Triad (33% of pts)
- Hypotension, muffled heart sounds, JVD
Diagnosis
- Ultrasound
- Pericardial effusion
- RV diastolic collapse, effusion, there is often RA systolic and diastolic collapse seen also
- 5% false negative (usually b/c pericardium is decompressing into L chest)
- Be suspicious if pt has a left-sided pulmonary effusion
- Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variablility of transvalvular flow, this is due to the phenomenon of ventricular interdependence
- ECG
- Tachycardia (bradycardia is ominous finding)
- Normal or low voltage
- Electrical alternans
- CXR
- Enlarged cardiac silhouette
- Pulsus Paradoxus
- >10mmHg change in sys BP on inspiration
Treatment
- Hemorrhagic Tamponade
- Pericardiocentesis
- Temporizing measure until thoracotomy can be performed
- IVF to increase RV volume
- Meds
- Pressors (temporizing)
- Avoid preload reducing meds (nitrates, diuretics)
- Pericardiocentesis
- Non-hemorrhagic Tamponade
- Pericardiocentesis
- Dialysis for pt w/ known renal failure
Disposition
- Admit with cardiology/CT surgery consult
See Also
Source
Tintinalli