Pericardial effusion and tamponade: Difference between revisions

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==Disposition==
==Disposition==
#Admit with cardiology/CT surgery consult
*Admit with cardiology/CT surgery consult


==See Also==
==See Also==

Revision as of 17:43, 7 March 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

  1. Hemopericardium
    1. Trauma
    2. Iatrogenic (misplaced central line)
    3. Bleeding diathesis
    4. Ventricular rupture (post-MI)
  2. Non-hemopericardium
    1. Cancer
    2. Pericarditis
      1. Infectious
      2. Uremic (renal failure)
    3. HIV complications (infection, Kaposi sarcoma, lymphoma)
    4. SLE
    5. Post-radiation
    6. Myxedema

Differential Diagnosis

Chest pain

Critical

Emergent

Nonemergent

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

  1. Ultrasound
    • 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
    • 5% false negative (usually because pericardium is decompressing into L chest)
    • Doppler interrogation across the mitral valve will demonstrate exaggerated respiratory variability of transvalvular flow, this is due to the phenomenon of ventricular interdependence
  2. ECG
    • Tachycardia (bradycardia is ominous finding)
    • Normal or low voltage
    • Electrical alternans, low voltage QRS
  3. CXR
    • Enlarged cardiac silhouette
  4. Pulsus Paradoxus
    • >10mmHg change in systolic BP on inspiration

Treatment

Hemorrhagic Tamponade

Non-hemorrhagic Tamponade

Disposition

  • Admit with cardiology/CT surgery consult

See Also

Source

Tintinalli