perioperativeCardiacTamponade

perioperativeCardiacTamponade - Donn Marciniak, MD Charles...

Info iconThis preview shows pages 1–15. Sign up to view the full content.

View Full Document Right Arrow Icon
Donn Marciniak, MD Charles Smith, MD March 18, 2008
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
68 y/o white female undergoing RFA for paroxysmal ventricular tachycarida PMH: DM, HTN, COPD All: erythromycin – nausea Soc: quit smoking 20 yrs ago, no EtOH or drugs
Background image of page 2
5 hours into RFA, decreased responsiveness, hypotensive Patient in SVT, paced out by cardiologists Remained hypotensive, pressors started, intubated Marked JVD noted
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
TTE emergently preformed 1.1-1.3cm effusion over right heart RV collaspe Tamponade physiology Effusion drained under ultrasound 35cc frank bloody fluid removed Patient immediately stabilized Extubated at end of case, taken to CICU Discharged 2 days later Continues medical management of SVT
Background image of page 4
A condition where fluid accumulates around the great vessels or chambers of the heart and decreases stroke volume to clinically significant levels
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
2 layers Parietal pericardium Fibrous ~2mm Visceral pericardium Thin mesothelial layer Typically contains 25 – 50cc serous fluid. Pericardial space can be considered a potential space
Background image of page 6
Slowly accumulating effusion Allows for pericardial distension May have effusion up to 1500cc before symptoms arise Typically ‘medical’ causes’ Uremia Malignancy Hypothyroidism Rapidly accumulating effusion Usually see in perioperative setting As little as 200cc fluid for symptoms
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Background image of page 8
Beck’s Triad Hypotension Jugular venous distension (Kussmal’s sign) Distant heart sounds
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Commonly sited changes: Low voltage QRS T wave inversions PR depression ST changes Not supported by data Combination of low voltage QRS and PR depression has weak association with effusion
Background image of page 10
Alteration in configuration of electrocardiographic complexes arising from the same pacemaker and independent of periodic extracardiac phenomenon Caused by swinging of the heart in pericardial fluid Rare phenomenon Resolves with drainage of effusion
Background image of page 11

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Decline in arterial pulse with negative pressure inspiration Not a paradox, but exaggeration of normal respiratory decrease in arterial BP assoc. with effusion Not an all-or none phenomonon
Background image of page 12
Systolic pressure change greater than 10 accepted as significant Respiratory variation switched with positive pressure ventilation Curtiss et al: SBP change greater than 12mm HG or 9% 92% and 97% accurate respectively
Background image of page 13

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
May be found in other conditions: Tracheal compression Tension pneumothorax Pleural effusion RV infarct PE Hemorrhageic shock May be absent in:
Background image of page 14
Image of page 15
This is the end of the preview. Sign up to access the rest of the document.

This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

Page1 / 54

perioperativeCardiacTamponade - Donn Marciniak, MD Charles...

This preview shows document pages 1 - 15. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online