Pericardial effusion and tamponade

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

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

Pericardial Effusion.png

  1. ECG
    • Tachycardia (bradycardia is ominous finding)
    • Normal or low voltage
    • Electrical alternans, low voltage QRS
      • Limb lead QRS amplitudes ALL < 5 mm;[1]
      • OR precordial QRS amp ALL < 10 mm
  2. CXR
    • Enlarged cardiac silhouette
  3. 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

  1. Mattu A, Brady W. ECGs for the Emergency Physician 2, BMJ Books 2008.