Cardiac tamponade resident survival guide

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

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.^[1]

Characterize the symptoms:

❑ Prodrome:
♦Fever
♦Malaise
♦Myalgia
❑ Retrosternal or left precordial chest pain
♦Radiates to trapezius ridge
♦Can be pleuritic
♦Can simulate isquemia
♦Varies with posture

Auscultation:

❑ Pericardial rub
♦Monophasic
♦Biphasic
♦Triphasic

Perform ECG:

❑ Convexly elevated J-ST segment
❑ Determine ECK staging:
♦ Stage I: anterior and inferior concave ST segment elevation. PR segment 7,19 deviations opposite to P polarity
♦Early stage II: ST junctions return to the baseline, PR deviated
♦ Late stage II: T waves progressively flatten and invert
♦ Stage III: generalised T wave inversions
♦ Stage IV: ECG returns to prepericarditis state

Echocardiography:
❑ Effusion types B- D according to Horowitz classification

Evidence of pericardial effusion

Order lab tests:
❑ Inflammation markers:
♦ESR
♦CRP
♦LDH
❑ Markers of myocardial lesion:
♦Troponin I
♦CK MB

EKG Staging

Horowitz Classification

Dos

Don'ts

References

↑ 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.

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[pmid15120056-1] 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.

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