Cardiac tamponade resident survival guide: Difference between revisions
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===Common Causes=== | ===Common Causes=== | ||
* Acute cardiac tamponade | |||
- Ascending aortic dissection | |||
- Iatrogenic - central line insertion, pacemaker insertion, coronary interventions, myocardial biopsy | |||
- Penetrating [[trauma]] | |||
- Post [[myocardial infarction]] treatments - [[heparin]], [[thrombolytic]]s | |||
* Subacute cardiac tamponade | |||
==Management== | ==Management== | ||
Revision as of 22:46, 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
- Acute cardiac tamponade
- Ascending aortic dissection - Iatrogenic - central line insertion, pacemaker insertion, coronary interventions, myocardial biopsy - Penetrating trauma - Post myocardial infarction treatments - heparin, thrombolytics
- Subacute cardiac tamponade
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.