cardiac tamponade

By

Ahmed Sobhy Emara

PHD,MD,MRCS

Definitions��Pericardium : is double layered sac encircling the heart typically has 20-50 ml of fluid ���PERICARDIAL EFFUSION : “an abnormal accumulation of fluid in the pericardial sac”�so �CARDIAC TAMPONADE is “clinical syndrome caused by excessive accumulation of fluid in the pericardial sac, resulting in compromising cardiac output, a life threatening condition ����(tampon?????)�

• ↑ intrapericardial Pressure on rt side of heart � ↓Venous return Pooling of blood in the pulmonary capillaries ↓Stroke volume ↓CO � increase intrapericardial pressure equalizes RV diastolic Pressure Then equalizes LV diastoilic pressure Drop in cardiac output

PATHO-PHYSIOLOGY

• Malignancy� Infection - Viral, bacterial (tuberculosis), fungal � drugs - Hydralazine, procainamide, isoniazid, minoxidil � Postcoronary intervention (ie, coronary dissection and perforation) � Trauma � Cardiovascular surgery (postoperative pericarditis) � Postmyocardial infarction (free wall ventricular rupture, Dressler syndrome) � Connective tissue dissease - Systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis � Iatrogenic - After sternal biopsy, transvenous pacemaker lead implantation, pericardiocentesis, or central line insertion � Uremia �:

ETIOLOGY

Dyspnea �, Chest pain�, Abdominal pain,� Fatigue,� Fever,� Cough�, Weakness�, Palpitation,� Maybe in shock, �thus not able to elicit symptoms �

Symptoms

signs

• Tachycardia
• Becks triad.
• distant or muffled heart sounds
• Jugular vein distension
• falling BP,
• paradoxical pulse (a drop in inspiratoryBP by greater than 10mmHg).
• Hepatomegaly
• Evidence of chest wall trauma

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���������� For diagnosis:�� ECG sinus tachy ,low voltage QRS complexes , • electrical alterans, PR depression�� CXR: large, globular heart, enlarge cardiac silhouette, water bottle shaped heart��  ECHO: “diagnostic test of choice “collapse of the right ventricular, Swinging of the heart in its sac .In tamponade, near equalization (within 5 mm Hg) of the right atrial, right ventricular diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressure � CT scan� For eliciting of the cause:�  complete blood count (CBC)• RFT,LFT• PT,INR• CKMB, TROP-T• ANA assay,• ESR• Rh FACTOR• HIV testing• Mantoux test• Pericardial fluid analysis�

INVESTIGATIONS

Management�

A)First aid measures:

According to ABC Approch with stressing on:

• Oxygen theraby
• Volume expansion with I.V plasma and fluids to maintain adequate intravascular volume
• Inotropic drugs (i.e. dobutamine)

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B) Surgical Drainage:�

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Either by:

• Pericardiocentesis
• Pleuro pericardial window
• Pericardiectomy
• VATS

c) Treatment of the cause

• For example:
• NSAIDS & Aspirin in case of pericarditis
• Antibioticcs in case of burulent pericarditis
• Antituerculus drugs in case of TB

Tricks

• Stabs in chest
• Constrictive pericarditis
• Other conditions

Thanks