Cardiac tamponade resident survival guide: Difference between revisions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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

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)

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[1] Longmore, M., Wilkinson, I.B., Rajagopalan, S. (2004) (6th Ed.). Oxford Handbook of Clinical Medicine. Oxford: Oxford University Press ISBN 9780198568377

[2] Isselbacher, E.M., Cigarroa, J.E., Eagle, K.A. (1994). Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful? Circulation. Vol 90, 2375-2378

[3] Gwinnutt, C., Driscoll, P. (Eds) (2003) (2nd Ed.) Trauma Resuscitation: The Team Approach. Oxford: BIOS Scientific Publishers Ltd. ISBN 978-1859960097

[4] Mattson Porth, C. (Ed.) (2005) (7th Ed.) Pathophysiology: Concepts of Altered Health States. Philadelphia : Lippincott Williams & Wilkins ISBN 978-0781749886

[rupturelikeliness-5] *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)

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@@ Line 54: / Line 54: @@
 ==Management==
-Shown below is an algorithm showing acute pericarditis management.<ref name="pmid15120056">{{cite journal| author=Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al.| title=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. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 7 | pages= 587-610 | pmid=15120056 | doi=10.1016/j.ehj.2004.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15120056  }} </ref>
+{{familytree/start}}
-{{familytree/start |summary=PE diagnosis Algorithm.}}
+{{familytree | | | A01 | |A01=}}
-{{familytree | | | | | | | A01 | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms:'''<br>
+{{familytree | | | |!| | |}}
-❑ Prodrome:<br>
+{{familytree | | | B01 | |B01=}}
-♦[[Fever]] <br>  ♦[[Malaise]] <br>  ♦[[Myalgia]]<br>
+{{familytree | | | |!| | | | |}}
-❑ Retrosternal or left precordial [[chest pain]]:<br>
+{{familytree | | | C01 | | |C01=}}
-♦Radiates to trapezius ridge<br>  ♦Can be pleuritic <br>  ♦Can simulate ischemia <br>  ♦Varies with posture <br>
+{{familytree | | | |!| | |}}
-</div> }}
+{{familytree | | | D01 | |D01=}}
-{{familytree | | | | | | | |!| | | | | | | }}
+{{familytree | | | |!| | |}}
-{{familytree | | | | | | | C01 | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150% ">'''Auscultation:'''<br>
+{{familytree | | | E01 | | E01=}}
-❑ [[Pericardial rub]]<br>
+{{familytree | | | |!| | | |}}
-♦Monophasic<br>  ♦Biphasic<br>  ♦Triphasic <br>
+{{familytree | | | F01 | | |F01=}}
- </div>}}
+{{familytree | |,|-|^|-|.| |}}
-{{familytree | | | | | | | |!| | | | | | | }}
+{{familytree | G01 | | G02 | |G01=|G02=}}
-{{familytree | | | | | | | D01 | | | | | | |D01=<div style="float: left; text-align: left; line-height: 150% ">'''Perform ECG:'''<br>
+{{familytree | |`|-|v|-|'| | |}}
-❑ Convexly elevated J-ST segment<br>
+{{familytree | | | H01 | H01=}}
-❑ Determine ECK staging:<br> ♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity <br> ♦ Early stage II: ST junctions return to the baseline, PR deviated <br> ♦ Late stage II: T waves progressively flatten and invert <br> ♦ Stage III: generalised T wave inversions <br> ♦ Stage IV: ECG returns to prepericarditis state
+{{familytree | | | |!| | |}}
- </div>}}
+{{familytree | | | I01 | | |I01=}}
-{{familytree | | | | | | | |!| | | | | | | | }}
+{{familytree | | | |!| |}}
-{{familytree | | | | | | | E01 | | | | | | | | |E01= <div style="float: left; text-align: left; line-height: 150% ">'''Echocardiography:'''<br> ❑ Effusion types B- D according to Horowitz classification: <br> ♦ Type A: No effusion <br> ♦ Type B: Separation of epicardium and pericardium (3–16 ml)<br> ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion >16 ml)<br> ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion<br> ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space<br> ♦ Type E: Pericardial thickening (>4 mm)</div>}}
+{{familytree | | | J01 | |J01=}}
-{{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}
-{{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=<div style="float: left; text-align: left; line-height: 150% ">'''Order lab tests:''' <br> ❑  Inflammation markers: <br>♦[[ESR]] <br> ♦[[CRP]] <br> ♦[[LDH]] <br> ❑ Markers of myocardial lesion:<br> ♦[[Troponin I]] <br> ♦[[CK MB]]</div> }}
-{{familytree | |,|-|^|-|.| | | | | |!| | | | }}
-{{familytree | G01 | | G02 | | | | G03 | | |G01=Large recurrent effusion| G02=Signs of cardiac tamponade|G03= Perform [[chest X-Ray]]: <br>❑ “water bottle” heart shadow}}
 {{familytree/end}}