Cardiac Tamponade

Pericadium

  • Membrane that consists of two layers surrounding the heart.
  • Normally minimal fluid within this space usually less than 50ml.
  • Accumulation of fluid results in high intrapericardial pressure which can result in compression of the cardiac chambers.
  • The right ventrical is more sensitive to changes in intrapericardial pressure.


Clinical Features

  • Hypoperfusion/Hypotension
  • Tachycardia
  • Shortness of Breath
  • Elevated JVP (Blunted Y-Descent)
  • Muffled Heart Sounds
  • Classic “Beck’s Triad” (Elevated JVP, Hypotension, muffled heart sound) rarely seen.
  • Pulsus Paradoxus: Reduction of systolic blood pressure of more than 10mmHg on inspiration.

Echo Features of Tamponade

Parasternal Long Axis View

  • Confirms circumfrential pericaridial effusion
  • Notice the complex fibrin.
  • Question of RV collapse in this view.

Parasternal Short Axis View at Level of Aortic Valve

  • Note again circurrential pericardial effusion
  • RV collapse in diastole.

Parasternal Short Axis View just below the Pap muscles

  • Demonstrates circumferential pericardial effusion.
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