TOC | Cardiology    CARDIAC TAMPONADE
See also Pericarditis  |  Pericardial Effusion

A. ETIOLOGIES                                    

1. Infection: viral, bacterial, parasitic, fungal
2. Systemic: uremia, various connective tissue disease as SLE, sarcoidosis
3. Drug: Procainamide, Quinidine, hydralazine, ?Dilantin
4. Myocardial infarction
5. Radiation pericarditis
6. Neoplasm: metastatic spread, primary pericardial tumor
7. Postcardiac injury : after open heart surgery, chest trauma, Dressler's syndrome
8. Hemopericardium: pacemaker perforation, anticoatulant Rx, ventricular rupture, pseudoaneurysm rupture, rupture of aneurysm of ascending aorta.

B. DIAGNOSIS:

• SX: falling blood pressure, tachycardia, tachypnea, pulsus 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.
• Cardiac cathetherization: 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.)

C. TREATMENT:

1. Emergency pericardiocentesis to remove the fluid, or Pericardiostomy (surgical opening of the pericardial sac - window)
2. 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.
3. Specific treatment of the underlying cause.

08172003