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 | 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.