Cardiac Tamponade

From Anvita Health Wiki

Contents 1 Introduction 2 Etiology 3 Epidemiology 4 Clinical-manifestations 5 Laboratory 6 Radiology 7 Management 8 More General Terms 9 Additional Terms 10 References

Introduction

• Heart failure secondary to compression of cardiac chambers by fluid within the pericardial space.

Etiology

• pericarditis of any cause
• viral & neoplastic forms of pericarditis most common

Epidemiology

• slightly more common in men than women [4] Pathophysiology
• accumulation of fluid within the pericardial space
• increased intrapericardial pressure
• as little as 30 mL in the pericardial sac can cause pericardial tamponade

Clinical-manifestations

• abrupt onset
• dyspnea, orthopnea
• elevation of central venous & jugular venous pressure

• no prominent y descent
• prominent x descent

• hepatic engorgement
• hypotension
• narrow pulse pressure
• pulsus paradoxus is common
• sinus tachycardia
• evidence of poor peripheral perfusion
• distant heart sounds
• pulseless electrical activity

Laboratory

• serum tropnonin I

• cardiac-specific troponin-I, elevated in patients with myocardial infarction & cardiac trauma

• serum creatinine/ serum urea nitrogen to assess for uremia
• complete blood count ( CBC)
• coagulation panel: assess bleeding risk
• antinuclear antibody assay, erythrocyte sedimentation rate, & rheumatoid factor: nonspecific, but may suggest connective tissue disease as predisposing factor
• HIV testing: 24% of all pericardial effusions may be associated with HIV infection.
• PPD testing: rule out tuberculosis Special Laboratory:
• electrocardiogram ( EKG)

• tachycardia
• low voltage
• electrical alternans

• echocardiography

• no thickened pericardium
• no pericardial calcifications
• pericardial effusion
• right ventricular size generally small
• myocardial thickness generally normal
• right atrial & right ventricular diastolic collapse
• increased right-sided flow during inspiration
• respiratory variation of trans-mitral flow

• right heart catheterization

• elevated, atrial/ventricular equalized diastolic pressure

Radiology

• chest X-ray may show cardiomegaly, water bottle-shaped heart, pericardial calcifications, or evidence of chest wall trauma Differental diagnosis:
• cardiogenic shock
• constrictive pericarditis
• pulmonary embolism
• tension pneumothorax [4]

Management

• pericardiocentesis

• ECG &/or echocardiographic guidance
• blood from pericardium does not clot

• supportive prior to definitive therapy

• inotropic agents
• aggressive administration of IV saline to maintain adequate ventricular filling
• preload- reducing agents are *absolutely contraindicated*

• diuretics
• nitrates

• mechanical ventilation exacerbates hemodynamic compromise; avoid if possible [2]

• surgical pericardiotomy

• may be done with videothorascopic guidance
• percutaneous balloon pericardiotomy for patients who as poor surgical candidates

• subacute cardiac tamponade with mild hemodynamic compromise may be managed conservatively

• serial hemodynamic monitoring
• serial echocardiography
• mananagement of volume status
• treatment of causative disorder [2]

More General Terms

• pericardial disease

Additional Terms

• pericardiocentesis

References

1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 135
2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15 American College of Physicians, Philadelphia 1998, 2006, 2009
3. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1097
4. eMedicine: Cardiac Tamponade [1]

cardiac tamponade