Pericardial effusion and tamponade: Difference between revisions
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==Background== | ==Background== | ||
*80% | *Always consider in pt w/ PEA | ||
*GSW is less likely to result in tamponade b/c pericardial defect is larger | *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 | *Pathophysiology | ||
**Increased pericardial pressure > decreased | **Increased pericardial pressure > decreased RV filling > decreased CO | ||
==Etiology== | ==Etiology== | ||
# | #Hemopericardium | ||
# | ##Trauma | ||
# | ##Iatrogenic (misplaced central line) | ||
# | ##Bleeding diathesis | ||
# | ##Ventricular rupture (post-MI) | ||
#Non-hemopericardium | |||
##Cancer | |||
##Pericarditis | |||
##HIV complications (infection, Kaposi sarcoma, lymphoma) | |||
##Renal failure | |||
##SLE | |||
##Post-radiation | |||
##Myxedema | |||
==DDx== | ==DDx== | ||
#Tension PTX | #Tension PTX | ||
#PE | #PE | ||
#Aortic dissection | |||
#SVC syndrome | #SVC syndrome | ||
#Large pleural effusion | #Large pleural effusion/hemothorax | ||
#Constrictive pericarditis | #Constrictive pericarditis | ||
#Cardiogenic shock | #Cardiogenic shock | ||
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*Narrow pulse pressure | *Narrow pulse pressure | ||
*Friction rub | *Friction rub | ||
*Beck's Triad ( | *Beck's Triad (33% of pts) | ||
**Hypotension, muffled heart sounds, JVD | **Hypotension, muffled heart sounds, JVD | ||
| Line 35: | Line 44: | ||
###Be suspicious if pt has a left-sided pulmonary effussion | ###Be suspicious if pt has a left-sided pulmonary effussion | ||
#ECG | #ECG | ||
##Tachycardia (bradycardia is ominous finding) | |||
##Normal or low voltage | ##Normal or low voltage | ||
##Electrical alternans | ##Electrical alternans | ||
#CXR | |||
##Enlarged cardiac silhouette | |||
#Pulsus paradoxus | #Pulsus paradoxus | ||
##>10mmHg change in sys BP on inspiration | ##>10mmHg change in sys BP on inspiration | ||
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==See Also== | ==See Also== | ||
*[[Pericardiocentesis]] | |||
*[[Thoracic Trauma]] | *[[Thoracic Trauma]] | ||
*[[Pericarditis]] | *[[Pericarditis]] | ||
Revision as of 05:02, 6 May 2012
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
- Hemopericardium
- Trauma
- Iatrogenic (misplaced central line)
- Bleeding diathesis
- Ventricular rupture (post-MI)
- Non-hemopericardium
- Cancer
- Pericarditis
- HIV complications (infection, Kaposi sarcoma, lymphoma)
- Renal failure
- SLE
- Post-radiation
- Myxedema
DDx
- Tension PTX
- PE
- Aortic dissection
- SVC syndrome
- Large pleural effusion/hemothorax
- Constrictive pericarditis
- Cardiogenic shock
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
- Ultrasound
- RV collapse, effusion
- 5% false negative (usually b/c pericardium is decompressing into L chest)
- Be suspicious if pt has a left-sided pulmonary effussion
- ECG
- Tachycardia (bradycardia is ominous finding)
- Normal or low voltage
- Electrical alternans
- CXR
- Enlarged cardiac silhouette
- Pulsus paradoxus
- >10mmHg change in sys BP on inspiration
Treatment
- IVF to increase RV volume
- Meds
- Pressors (temporizing)
- Avoid preload reducing meds (nitrates, diuretics)
- Pericardiocentesis
Disposition
- Likely ICU
- Cardiology, CT surgery consultations
See Also
Source
Tintinalli