Identification of cardiac tamponade

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Identification of cardiac tamponade

• Dr. Sumit Talwar, M.D.
• Johns Hopkins University/ Sinai Hospital Program
  in Internal Medicine

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Cardiac tamponade

• Definition Accumulation of pericardial fluid
  under pressure causing compression of heart.
• Acute
• Trauma, Iatrogenic
• Subacute
• Neoplastic, Uremic, Idiopathic

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Diagnosis

• Physical exam !!!
• Electrocardiogram
• Echocardiogram
• Chest X Ray

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Physical Examination

• BECKs Triad
• Distant Heart Sounds
• Elevated JVD
• Hypotension

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HEENT

• Elevated JVD
• x descent is preserved
• y descent is decreased or absent
• Kussmauls sign
• Lack of decrease or
• increase of JVD with inspiration
• Usually seen when constriction
• is present

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Pulsus Paradoxus

• gt10 mmHg decrease in SBP on inspiration
• Present in pulmonary embolism, asthma, COPD
• Absent in rapid heart rate, irregular rhythm,
  ASD, sev. AR, regional tamponade, inc. LV
  diastolic pressure

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• CVS
• Tachycardia
• Hypotension (occasionally hypertensive)
• Cool extremities
• Pericardial rub (30)
• Muffled heart sounds
• Other
• Tachypnea with clear lung sounds

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EKG

• Sinus
• Tachycardia
• Low Voltage
• Electrical
• alternans

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Pericarditis

• diffuse upsloping ST segment elevations leads II,
  III, aVF, and V3 to V6
• ST concave upwards
• PR segment elevation in aVR and PR segment
  depression in other limb leads, V5 and V6

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Chest X Ray
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• Echocardiography
• Pericardial effusion
• Collapse of right atrium and right ventricle
  during diastole
• Left atrial collapse in 25 patients
• Dilatation of IVC and lt 50 decrease in diameter
  during inspiration
• Respiratory variation of mitral/ tricuspid
  velocities and RV/ LV volumes.

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