Cardiac tamponade resident survival guide: Difference between revisions
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==Causes== | ==Causes== | ||
===Causes in Alphabetical Order=== | |||
*[[Amyloidosis]] | |||
*[[Anticoagulant therapy]] <ref>Longmore, M., Wilkinson, I.B., Rajagopalan, S. (2004) (6th Ed.). Oxford Handbook of Clinical Medicine. Oxford: Oxford University Press ISBN 9780198568377 </ref>. | |||
*[[Aortic dissection]] <ref>Isselbacher, E.M., Cigarroa, J.E., Eagle, K.A. (1994). Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful? Circulation. Vol 90, 2375-2378</ref> | |||
*Bacterial [[pericarditis]] | |||
*[[Bronchogenic cyst]] | |||
*[[Cancer]] | |||
*[[Chest trauma]] (both blunt and penetrating) <ref>Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097 </ref> | |||
*[[Constrictive pericarditis]] | |||
*[[Dilated cardiomyopathy]] | |||
*[[Dissecting aortic aneurysm]] | |||
*[[Dressler syndrome]] | |||
*During cardiac surgery <ref>Mattson Porth, C. (Ed.) (2005) (7th Ed.) Pathophysiology: Concepts of Altered Health States. Philadelphia : Lippincott Williams & Wilkins ISBN 978-0781749886 </ref> | |||
*[[Hypothyroidism]] | |||
*[[Malignancy]] | |||
*[[Mycobacterium tuberculosis]] | |||
*[[Myocardial rupture]]. Myocardial rupture typically happens in the subacute setting after a [[myocardial infarction]] (heart attack), in which the infarcted muscle of the heart thins out and tears. Myocardial rupture is more likely to happen in females, the elderly, patients with hypertension, and individuals without any previous[[heart|cardiac]] history who suffer from their first heart attack and are not revascularized with [[thrombolytic]] therapy, [[percutaneous coronary intervention]], or with[[coronary artery bypass graft surgery]].<ref name="rupturelikeliness">*{{cite journal | |||
| first=A | |||
| last=Meniconi | |||
| authorlink= | |||
| coauthors=C H ATTENHOFER JOST, R JENNI | |||
| year=2000 | |||
| month=November | |||
| title=How to survive myocardial rupture after myocardial infarction | |||
| journal=Heart | |||
| volume=84 | |||
| issue=5 | |||
| pages = | |||
| id= PMID 11040020 | |||
| url=http://heart.bmj.com/cgi/content/full/84/5/552 | |||
}}</ref> These patients often have single vessel disease without the development of [[collateral]]s. | |||
*Penetrating cardiac injury | |||
*[[Pericarditis]] | |||
*Physical trauma | |||
*[[Postpericardiotomy syndrome]] | |||
*Pyogenic [[pericarditis]] | |||
*Rheumatoid pericarditis | |||
*[[Scrub typhus]] | |||
*[[Tuberculous pericarditis]] | |||
*[[Uremia]] | |||
*[[Uremic pericarditis]] | |||
*[[Ventricular aneurysm]] | |||
*Viral [[pericarditis]] | |||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. | Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. | ||
Revision as of 20:28, 17 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]
Definitions
Causes
Causes in Alphabetical Order
- Amyloidosis
- Anticoagulant therapy [1].
- Aortic dissection [2]
- Bacterial pericarditis
- Bronchogenic cyst
- Cancer
- Chest trauma (both blunt and penetrating) [3]
- Constrictive pericarditis
- Dilated cardiomyopathy
- Dissecting aortic aneurysm
- Dressler syndrome
- During cardiac surgery [4]
- Hypothyroidism
- Malignancy
- Mycobacterium tuberculosis
- Myocardial rupture. Myocardial rupture typically happens in the subacute setting after a myocardial infarction (heart attack), in which the infarcted muscle of the heart thins out and tears. Myocardial rupture is more likely to happen in females, the elderly, patients with hypertension, and individuals without any previouscardiac history who suffer from their first heart attack and are not revascularized with thrombolytic therapy, percutaneous coronary intervention, or withcoronary artery bypass graft surgery.[5] These patients often have single vessel disease without the development of collaterals.
- Penetrating cardiac injury
- Pericarditis
- Physical trauma
- Postpericardiotomy syndrome
- Pyogenic pericarditis
- Rheumatoid pericarditis
- Scrub typhus
- Tuberculous pericarditis
- Uremia
- Uremic pericarditis
- Ventricular aneurysm
- Viral pericarditis
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Management
Shown below is an algorithm showing acute pericarditis management.[6]
Characterize the symptoms: ❑ Prodrome: | |||||||||||||||||||||||||||||||||
Auscultation: ❑ Pericardial rub | |||||||||||||||||||||||||||||||||
Perform ECG: ❑ Convexly elevated J-ST segment | |||||||||||||||||||||||||||||||||
Echocardiography: ❑ Effusion types B- D according to Horowitz classification: ♦ Type A: No effusion ♦ Type B: Separation of epicardium and pericardium (3–16 ml) ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion >16 ml) ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space ♦ Type E: Pericardial thickening (>4 mm) | |||||||||||||||||||||||||||||||||
| Evidence of pericardial effusion | Order lab tests: ❑ Inflammation markers: ♦ESR ♦CRP ♦LDH ❑ Markers of myocardial lesion: ♦Troponin I ♦CK MB | ||||||||||||||||||||||||||||||||
| Large recurrent effusion | Signs of cardiac tamponade | Perform chest X-Ray: ❑ “water bottle” heart shadow | |||||||||||||||||||||||||||||||
Dos
Don'ts
References
- ↑ Longmore, M., Wilkinson, I.B., Rajagopalan, S. (2004) (6th Ed.). Oxford Handbook of Clinical Medicine. Oxford: Oxford University Press ISBN 9780198568377
- ↑ Isselbacher, E.M., Cigarroa, J.E., Eagle, K.A. (1994). Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful? Circulation. Vol 90, 2375-2378
- ↑ Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097
- ↑ Mattson Porth, C. (Ed.) (2005) (7th Ed.) Pathophysiology: Concepts of Altered Health States. Philadelphia : Lippincott Williams & Wilkins ISBN 978-0781749886
- ↑ *Meniconi, A (2000). "How to survive myocardial rupture after myocardial infarction". Heart. 84 (5). PMID 11040020. Unknown parameter
|coauthors=ignored (help); Unknown parameter|month=ignored (help) - ↑ Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y; et al. (2004). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology". Eur Heart J. 25 (7): 587–610. doi:10.1016/j.ehj.2004.02.002. PMID 15120056.