Cardiac tamponade resident survival guide: Difference between revisions

Revision as of 19:22, 17 January 2014

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:
♦ 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

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.

[1]

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-{{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''<br> ❑ Effusion types B- D according to [[Cardiac tamponade resident survival guide#Horowitz classification|Horowitz classification]]  }}
+{{familytree | | | | | | | E01 | | | | | | | | |E01= '''Echocardiography:'''<br> ❑ Effusion types B- D according to Horowitz classification: <br> ♦ Type A: No effusion <br> ♦ Type B: Separation of epicardium and pericardium (3–16 ml)<br> ♦ Type C 1: Systolic and diastolic separation of epicardium and pericardium (small effusion >16 ml)<br> ♦ Type C 2: Systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion<br> ♦ Type D: Pronounced separation of epicardium and pericardium with large echo- free space<br> ♦ Type E: Pericardial thickening (>4 mm)}}
 {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | }}
 {{familytree | | | F01 | | | | | | F02 | | | | |F01='''Evidence of pericardial effusion''' |F02=<div style="float: left; text-align: left; line-height: 150% ">'''Order lab tests:''' <br> ❑  Inflammation markers: <br>♦[[ESR]] <br> ♦[[CRP]] <br> ♦[[LDH]] <br> ❑ Markers of myocardial lesion:<br> ♦[[Troponin I]] <br> ♦[[CK MB]]</div> }}
 {{familytree | | | |!| | | | | | | | | | | | }}
 {{familytree/end}}
 ==Horowitz Classification==