Cardiac tamponade resident survival guide

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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 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
 
 

Horowitz Classification

Dos

Don'ts

References

  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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