Pericardial effusion and tamponade: Difference between revisions

Revision as of 00:42, 18 June 2015

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

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

Pericardiocentesis
- Temporizing measure until thoracotomy can be performed
IVF to increase RV volume
Medications
- Pressors (temporizing)
- Avoid preload reducing medications (nitrates, diuretics)

Authors:

@@ Line 37: / Line 37: @@
 #*Pericardial effusion
 #**In acute cases, even a relatively small build up of pericardial fluid can lead to hemodynamic compromise
-#*RV diastolic collapse, effusion, there is often RA systolic and diastolic collapse seen also
+#*Diastolic collapse of the right atrium (in atrial diastole)
-#*5% false negative (usually because pericardium is decompressing into L chest)
+#*Diastolic collapse of the right ventricle
-#**Be suspicious if patient has a left-sided [[pulmonary effusion]]
+#*Plethoric IVC
-#* Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow, this is due to the phenomenon of ventricular interdependence
+#*Valvular pulsus parodoxus
+#**Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow
 [[File:Pericardial Effusion.png|300px]]
 #[[ECG]]