See also Pericarditis |
Infection: viral, bacterial, parasitic, fungal
Systemic: uremia, various connective tissue disease as SLE,
Drug: Procainamide, Quinidine, hydralazine, ?Dilantin
Neoplasm: metastatic spread, primary pericardial tumor
Postcardiac injury : after open heart surgery, chest trauma, Dressler's
Hemopericardium: pacemaker perforation, anticoatulant Rx, ventricular rupture,
pseudoaneurysm rupture, rupture of aneurysm of ascending aorta.
SX: falling blood pressure, tachycardia,
paradoxus >10 mmHg, cardiomegaly on x ray, EKG may show pericarditis
ST T changes, low QRS voltage, electrical alternans, & predisposing
conditions as mentioned above.
Echocardiogram: pericardial effusion
with prolonged right atrial compression esp. lasting >34% of the cardiac
cycle, & right ventricular end diastolic compression.
CT Scan or MRI are also highly reliable.
equalization of right atrial, pulm.artery end diastolic, right
ventricular end diastolic, & pulm wedge pressures within 5 mmHg of each
other (the major exception is in pts with preexisting left heart failure,
in whom lef sided pressures will remain higher than right sided pressures.)
Emergency pericardiocentesis to remove the fluid, or Pericardiostomy
(surgical opening of the pericardial sac - window)
Avoid hypovolemia; may give IV fluid for hypotension as needed.
The systemic arterial pressure & cardiac output may be supported by infusion
of drugs such as dopamine, dobutamine, or isoproterenol.
Specific treatment of the underlying cause.