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]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Management

Shown below is an algorithm showing acute pericarditis management.

Characterize the symptoms: ❑ Prodrome: ♦Fever ♦Malaise ♦Myalgia ❑ Retrosternal or left precordial chest pain: ♦Radiates to trapezius ridge ♦Can be pleuritic ♦Can simulate ischemia ♦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: ♦ Type A: No effusion ♦ Type B: Separation of epicardium and pericardium (3–16 ml) ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion >16 ml) ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space ♦ Type E: Pericardial thickening (>4 mm)

Evidence of pericardial effusion

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

Large recurrent effusion

Signs of cardiac tamponade

Perform chest X-Ray: ❑ “water bottle” heart shadow