Cardiac Tamponade
Always consider tamponade in a patient with PEA or penetrating trauma to the chest - Taryn Hoffman
image by: www.scientificanimations.com
HWN Recommends
EM@3AM – Cardiac Tamponade
Pearls:
- 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.
Resources
Cardiac Tamponade... In a Rush
This is a CANNOT MISS diagnosis and should always be on our mind when a patient walks in complaining of chest pain and/or shortness of breath. There are multiple causes of cardiac tamponade, however most cases are idiopathic. If your patient has Becks triad AND pulses paradoxus, grab that bedside ultrasound and evaluate for cardiac tamponade!
Paucis Verbis: Cardiac tamponade or just an effusion?
The Beck’s triad of hypotension, distended neck veins, and muffled heart sounds are important to remember … only on tests. Think about performing a pulsus paradoxus test to see if it’s >12 mmHg. This is a sign of physiologic compromise. Note that the typical cutoff has been 10 mmHg but 12 mmHg is a more specific test.
Tamponade or No Tamponade: That is the question
Bedside ultrasonography for evaluation of cardiac tamponade is an essential skill for the emergency medicine physician. Determining whether tamponade is present can dramatically change management and the rapidity with which intervention has to be performed.
Ultrasonography of Cardiac Tamponade
Using dynamic ultrasonography, the ED team performed pericardiocentesis and placed a pericardial drain with significant improvement in hemodynamic status.
Check engine: cardiac tamponade
On this episode collaboration with ACEP PEER IX, we cover high yield must-know info for tamponade. We also try to sound smart saying electrical altering multiple times.
Pericarditis and Cardiac Tamponade
Cardiac tamponade is a clinical diagnosis, not an imaging one. While the larger the pericardial effusion, the more likely cardiac tamponade, it is not the size of the effusion alone that matters. Rather, it is the pressure on the right side of the heart that is the keystone of tamponade physiology. Small effusions that collect rapidly can lead to tamponade.
Should I Drain That? Lessons on Cardiac Tamponade
The majority of pericardial effusions occur in patients with normal vital signs, and as mentioned above, the size of the effusion alone does not reliably predict hemodynamic compromise or cardiac tamponade. Furthermore, even patients in very early tamponade may compensate for the resultant decreased cardiac filling, leading to falsely reassuring vital signs. For these reasons, it is vital that emergency physicians be able to determine the presence or absence of tamponade physiology on ultrasound.
EM@3AM – Cardiac Tamponade
Evidence regarding the use of inotropes is lacking – consider milrinone or dobutamine (reduce elevated vascular resistance).
EM Daily
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.
Maimonides Emergency Medicine
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.
StatPearls
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.
Introducing Stitches!
Your Path to Meaningful Connections in the World of Health and Medicine
Connect, Collaborate, and Engage!
Coming Soon - Stitches, the innovative chat app from the creators of HWN. Join meaningful conversations on health and medical topics. Share text, images, and videos seamlessly. Connect directly within HWN's topic pages and articles.
