Always consider tamponade in a patient with PEA or penetrating trauma to the chest - Taryn Hoffman
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- Beck’s triad (JVD, muffled heart sounds, hypotension), pulsus paradoxus, EKG changes, peripheral edema, and hepatomegaly are non-specific in the identification of subacute/chronic cardiac tamponade.
- Electrical alternans is present in less than 1/3 of patients with cardiac tamponade.
- Pulsus paradoxus may occur in the setting of massive PE, hemorrhagic shock, or obstructive lung disease.
- The use of electrocardiography during the performance of pericardiocentesis is no longer advised as attaching an electrode to the pericardiocentesis needle often provides misleading results.
Evidence regarding the use of inotropes is lacking – consider milrinone or dobutamine (reduce elevated vascular resistance).
Besides hemorrhage (from something such as a stab wound or a left ventricular wall rupture s/p MI), other risk factors include infection (i.e., TB, myocarditis), autoimmune diseases, neoplasms, uremia, inflammatory disorder such as pericarditis.
And remember.. tamponade physiology depends on the rate of fluid accumulation and the compliance of the pericardium, NOT the volume of the effusion. A slowly developing effusion may become quite large without causing tamponade, whereas a quickly filling effusion may cause tamponade with only a small volume.
Patients with cardiac tamponade present similar to patients with other forms of cardiogenic or obstructive shock. They may endorse vague symptoms of chest pain, palpitations, shortness of breath, or in more severe cases, dizziness, syncope, and altered mental status. They may also present in a pulseless electrical activity cardiac arrest.
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