Pericardial effusion and tamponade

Background

• 80% of myocardial stab wounds develop cardiac tamponade
• GSW is less likely to result in tamponade b/c pericardial defect is larger
• Pathophysiology
  • Increased pericardial pressure > decreased diastolic filling > collapse of RA

Etiology

1. Metastatic malignancy
2. Pericarditis
3. Uremia
4. Hemorrhage (anticoagulant)
5. Other (SLE, postradiation, myxedema)

DDx

1. Tension PTX
2. PE
3. SVC syndrome
4. Large pleural effusion
5. Tension pneumocardium
6. Constrictive pericarditis
7. Cardiogenic shock

Clinical Features

• Rapidity of fluid accumulation determines signs/symptoms
  • CP, SOB, fatigue
  • CHF-type appearance
  • Narrow pulse pressure
  • Friction rub
  • Beck's Triad (30% of pts)
    • Hypotension, muffled heart sounds, JVD

Diagnosis

1. Ultrasound
   1. RV collapse, effusion
   2. 5% false negative (usually b/c pericardium is decompressing into L chest)
      1. Be suspicious if pt has a left-sided pulmonary effussion
2. ECG
   1. Normal or low voltage
   2. Electrical alternans
3. Pulsus paradoxus
   1. >10mmHg change in sys BP on inspiration

Treatment

• IVF to increase RV volume
• Meds
  • Pressors (temporizing)
  • Avoid preload reducing meds (nitrates, diuretics)
• Pericardiocentesis

Disposition

1. Likely ICU
2. Cardiology, CT surgery consultations

See Also

• Thoracic Trauma
• Pericarditis

Source

Tintinalli