Cardiac tamponade resident survival guide: Difference between revisions

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{{CMG}}; {{AE}} {{KGH}} {{AO}}
{{CMG}}; {{AE}} {{KGH}} {{AO}}
==Definition==
==Definition==
This is a medical emergency which involves a slow or rapid compression of the heart due to the accumulation of fluid, pus, blood, clots, or gas in the pericardium, as a result of efusion, trauma, or rupture of the heart.<ref name="Spodick-2003">{{Cite journal  | last1 = Spodick | first1 = DH. | title = Acute cardiac tamponade. | journal = N Engl J Med | volume = 349 | issue = 7 | pages = 684-90 | month = Aug | year = 2003 | doi = 10.1056/NEJMra022643 | PMID = 12917306 }}</ref>  It is suspected based on history, physical examination, and chest imaging findings, but it is confirmed based on the clinical response observed during or post-pericardial fluid drainage.
This is a medical emergency which involves a slow or rapid compression of the heart due to the accumulation of [[fluid]], [[pus]], [[blood]], [[clots]], or [[gas]] in the [[pericardium]], as a result of effusion, trauma, or rupture of the heart.<ref name="Spodick-2003">{{Cite journal  | last1 = Spodick | first1 = DH. | title = Acute cardiac tamponade. | journal = N Engl J Med | volume = 349 | issue = 7 | pages = 684-90 | month = Aug | year = 2003 | doi = 10.1056/NEJMra022643 | PMID = 12917306 }}</ref>  It is suspected based on history, physical examination, and chest imaging findings, but it is confirmed based on the clinical response observed during or post-pericardial fluid drainage.


==Causes==
==Causes==

Revision as of 22:40, 26 January 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2] Ayokunle Olubaniyi, M.B,B.S [3]

Definition

This is a medical emergency which involves a slow or rapid compression of the heart due to the accumulation of fluid, pus, blood, clots, or gas in the pericardium, as a result of effusion, trauma, or rupture of the heart.[1] It is suspected based on history, physical examination, and chest imaging findings, but it is confirmed based on the clinical response observed during or post-pericardial fluid drainage.

Causes

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

  • Always suspect cardiac tamponade in any patient presenting with hypotension, tachycardia and distended neck veins (or elevated jugular venous pressure).
  • Always measure pulsus paradoxus whenever you suspect cardiac tamponade.
  • Consider the intrapericardial pressure more than the volume of the pericardial fluid in the management of cardiac tamponade.
  • The drainage of pericardial effusion should be gradual and slow to avoid the precipitation of pulmonary edema.
  • Echocardiography is the primary modality of choice, considering its high specificity and sensitivity, low cost and lack of radiation. CT and cardiac MRI are indicated when echocardiography is inconclusive.
  • Consider 2D and doppler echocardiography prior to discharge to confirm total removal or detect reaccumulation of pericardial fluid.

Don'ts

  • Never delay treatment whenever you suspect cardiac tamponade.
  • Avoid diuretics because it may worsen the central venous pressure.
  • Avoid placing pericardial fluid drainage catheter in situ for > 3 days.
  • Avoid the subcostal approach of pericardiocentesis if coagulopathy is present. Iatrogenic injuries to the liver may be life-threatening.
  • Avoid positive pressure mechanical ventilation. It may further reduce cardiac filling.
  • The use of inotropic agents for hemodynamic support should not be a substitute or cause a delay to pericadiocentesis.

References

  1. Spodick, DH. (2003). "Acute cardiac tamponade". N Engl J Med. 349 (7): 684–90. doi:10.1056/NEJMra022643. PMID 12917306. Unknown parameter |month= ignored (help)

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