Diagnosis

Cardiac tamponade

Etiology

Cause [74u]

• Cancer --> pleural effusion (>50% of cases)

  • Lung >70%

  • Breast

  • Renal

  • Lymphoma

  • Leukemia

• Uremia - 10-15%

• Pericarditis - 5-15%

• Infectious diseases - 5-10%

  • Staphylococcus aureus

  • Myobacterium tuberculosis

  • Staphylococcus pneumonia

  • HIV

  • Coxsackievirus group B

  • Invluenza

  • Echoviruses

  • Herpes

  • Histoplasma capsulatum

  • Histoplasmosis

  • Blastomycosis

• Drug-induced:

  • Hydralazine

  • Procainamide hydrochloride

  • Isoniazid

  • Minoxidil

• Trauma (2% of all penetrating injuries to the thorax)

• Anticoagulation - 5-10%

• Connective tissue diseases - 2-6%

  • Lupus

  • Rheumatoid arthritis

  • Dermatomyositis

• Myocardial infarction --> wall rupture (Dressler syndrome) - 1-2%

• Hypothyroidism

• Pneumopericardium

  • Mechanical ventilation

  • Gastric/esophageal fistula

• Iatrogenic causes:

  • Cardiovascular surgery

  • Central Vein Catheter

  • Coronary angiography/intervention

  • Pacemaker

  • Pericardiocentesis

  • Radiation therapy

Pathophysiology [gyy]

1. The pericardial space normally contains 20-50mL of fluid (lubrication)

2. Pathologic accumulation of pericardial fluid may impair diastolic filling based on:

   • rate of fluid accumulation (rapid accumulation of 150mL may be enough)

   • the compliance of the pericardium (gradual adaptive stretching of the pericardium)

3. Increased stiffness of the ventricle, requiring a higher filling pressure

4. Further fluid accumulation --> the pericardial pressure increases above the ventricular filling pressure --> reduced diastolic filling and reduced cardiac output

Complications

• Pulmonary edema

• Shock

• Death

Epidemiology

Incidence per 100.000 [gvi]

Approach

• Blood test (creatine kinase, troponin, coagulation panel, ANA, RF)

• Blood gas

• ECG

• Chest x-ray

• Echocardiography

• CT thorax

• Pericardiocentesis

Treatment

1. Oxygen [gyy]

2. Volume expansion with blood, plasma

3. Bed rest with leg elevation --> increase venous return

4. Hemodynamically stable patients --> Percutaneous Pericardiocentesis

5. Hemodynamically unstable patients --> Open Pericardiotomy

Differential diagnoses

Cancer, Cardiomyopathy, Endocarditis, Endomyocardial fibrosis, Heart failure, Myocardial infarction, Myocarditis, Pericarditis, Pleural effusion, Pneumothorax, Pulmonary embolism, Renal failure, Rheumatic fever, Shock, Tension pneumopericardium, Tuberculosis