cardiac tamponade อ ทศพล

7/21/2019 Cardiac Tamponade

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(Cardiac Tamponade)

(cardiac tamponade)

(cardiac tamponade) ()

(ventricular diastolic filling) (cardiac output)

15-30 .

80-200. 200 . 1 (stiff) (fibrosis)

(pericardial effusion) 1

1 (pericardial effusion)1,3(idiopathic pericarditis)/

(primary)

Mesothelioma, teratoma, fibroma,

Nephrotic syndrome


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, sarcoma, leukemia

(metastasis)Breast carcinoma, bronchogenic carcinoma,

lumphoma, melanoma, etc.

Coxsackie, echovirus, infectious

mononucleosis, HIV

Histoplasmosis, aspergillosis, etc.

Mycobacterium tuberculosis,

Staphylococcus,Streptococcus,Burkholderia(Pseudomonas)pseudomallei,bacterialendocarditis, etc.

Uremia, myxedema (hypothyroidism),

hypoalbuminemia

(radiation)Dissecting thoracic aortic aneurysm

(trauma)Pericardiotomy

Indirect trauma (catheter)

(acute MI)Delayed postmyocardial-pericardial injury

Post-MI (Dresslers syndrome)

Postpericardiotomy syndrome

Immunologic/ Inflammatory disorders

Rheumatic fever, SLE, ankylosing apondylitis,

rheumatoid arthritis, vasculitis, etc.

Procainamide, hydralazine, heparin, warfarin,

phenytoin, phenylbutazone, etc.

Topol EJ, Klein AL, Scalia GM. Disease if the pericardium, restrictive cardiomyopathy, and diastolicdysfunction. In: Topol EJ, editor. Comprehensive cardiovascular medicine. Philadelphia: Lippincott Williams & Wilkins;

1998. p. 669-733.

(muffled heart sounds

) (jugular vein

) prominentxdescent ydescent isolated left atrial tamponade

Paradoxical pulse (systolic BP) 10 .

Kussmauls sign (jugular vein) , right ventricular infarction


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Ewarts sign bronchial breath sounds egophony rales

low voltage QRS complex T-waves

electrical alternans (4)

(cardiac silhouette)

250 .5 (globular water bottle-shapedheart) (5) parietal pericardium epicardial

fat ( 1-2 .) (pulmonary congestion) hilar overlaysign

(transthoracic echocardiography) pericardial sac (diastolic phase) right atrial right ventricle collapse left atrial collapse (swinging heart)1

(MRI) (CT scan)

loculated effusion mediastinum

(right-heart catheterization) hemodynamic

(pericardiocentesis)

4 electrical alternans QRS complex ()


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5 massive pericardial effusion globular water bottle-shaped hearthilar overlaysign ()

pericardiocentesis (resuscitation)

(volume expanding agents) 0.9% normal saline RV


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diastolic collapse norepinephrine (levophed)

(pericardiocentesis)

(indications)1. 2. (open heart

surgery)

(Contraindications) absolute

relative contraindications 61.

(anticoagulant) prothrombin time (PT) partial thromboplastin time (PTT) PT INR 1.8 PTT 2 fresh frozen plasma

2.

(thrombocytopenia) 50,000 3.

Traumatic hemopericardium 4.

Type A aortic dissection (10-25 .) stabilized

5.

Subacute free wall rupture dissections free wall rupture 6.

Small posteriorly located effusion echocardiogram

7.

Purulent effusion 8.

Malignant effusion (recurrent) (pericardial window)

(echo-guided)6 (echocardiography)

(left lateral decubitus) 30


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echocardiography probe

(permanentmarkers) sterile providine iodine solution (1% lidocaine) (superioraspect) intercostal artery 18-gauge 3 (three-way stopcock) (syringe) (sterilehemostate) ( pericardium ) probe (0.035- guidewire)

(6-Fr dilator) (6-Fr 8-Fr pigtail catheter) 3 2 30 . (vacuum bottle) (drainage bag) (syringe)

(EKG-guided)6

(subxyphoid approach)

1. 45 2. EKG limb leads

3. (subxyphoid approach) process

4. 25-gauge5. 21-gauge 10

(sterile alligator clip) V lead

6. 30 (6) (costal margin)

7. ST elevation (7) premature ventricular contractions PR

elevation PACs right atrium 6-8 .


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8.

6 (subxyphoid approach)

7 ST elevation

1.

mycobacterium 2.

(cytologic examination)3. acid-fast bacillus

4.

(cell count) (protein) lactatedehydrogenase (LDH)

5.

complete blood count (CBC), blood chemistry, titers cytomegalovirus, coxsackie B virus, antinuclear antibody, rheumatoid titer


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Pneumothorax

Chamber entry /cardiac laceration

Arterial laceration left internal mammary artery ( 5 . ) posterior descending artery intercostal arteries (superior)

Infection

(pneumothorax)

1-2 (antibiotic ointment) 2-3 6

sterile saline 50 ./ (pericardial pain) nonsteroidal analgesics


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1.

Stein AB, Crawford PA. Disease of the pericardium. In: Crawford PA, Lin TL, eds. The

Washington manual subspecialty consult series: Cardiology subspecialty consult. Philadelphia:

Lippincott Williams & Wilkins; 2004. p. 200-7.

2.

Gokdstein JA. Cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy.

Curr Probl Cardiol 2004; 29: 503-67.

3.

Topol EJ, Klein AL, Scalia GM. Disease if the pericardium, restrictive cardiomyopathy, and

diastolic dysfunction. In: Topol EJ, editor. Comprehensive cardiovascular medicine.

Philadelphia: Lippincott Williams & Wilkins; 1998. p. 669-733.

4.

Beck C. Two cardiac compression triads. JAMA 1935;104:714-6.

5.

Reginelli JP, Wu J, Chetcutti S. Pericardial disease. In: Griffin BP, Topol EJ, eds. Manual of

cardiovascular medicine. Philadelphia: Lippincott Williams & Wilkins; 2004. p.372-96.

6.

Gring C, Griffin BP. Pericardiocentesis. In: Griffin BP, Topol EJ, eds. Manual of cardiovascular

medicine. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 709-13.

cardiac tamponade อ ทศพล

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