https://speciality.medicaldialogues.in/cardiac-tamponade-causes-symptoms-treatment/
Cardiac tamponade
Does This Patient With a Pericardial Effusion Have Cardiac Tamponade?
Context Cardiac tamponade is a state of hemodynamic compromise resulting from cardiac compression by fluid trapped in the pericardial space. The clinical examination may assist in the decision to perform pericardiocentesis in patients with cardiac tamponade diagnosed by echocardiography.
Objective To systematically review the accuracy of the history, physical examination, and basic diagnostic tests for the diagnosis of cardiac tamponade.
Data Sources MEDLINE search of English-language articles published between 1966 and 2006, reference lists of these articles, and reference lists of relevant textbooks.
Study Selection We included articles that compared aspects of the clinical examination to a reference standard for the diagnosis of cardiac tamponade. We excluded studies with fewer than 15 patients. Of 787 studies identified by our search strategy, 8 were included in our final analysis.
Data Extraction Two authors independently reviewed articles for study results and quality. A third reviewer resolved disagreements.
Data Synthesis All studies evaluated patients with known tamponade or those referred for pericardiocentesis with known effusion. Five features occur in the majority of patients with tamponade: dyspnea (sensitivity range, 87%-89%), tachycardia (pooled sensitivity, 77%; 95% confidence interval [CI], 69%-85%), pulsus paradoxus (pooled sensitivity, 82%; 95% CI, 72%-92%), elevated jugular venous pressure (pooled sensitivity, 76%; 95% CI, 62%-90%), and cardiomegaly on chest radiograph (pooled sensitivity, 89%; 95% CI, 73%-100%). Based on 1 study, the presence of pulsus paradoxus greater than 10 mm Hg in a patient with a pericardial effusion increases the likelihood of tamponade (likelihood ratio, 3.3; 95% CI, 1.8-6.3), while a pulsus paradoxus of 10 mm Hg or less greatly lowers the likelihood (likelihood ratio, 0.03; 95% CI, 0.01-0.24).
Conclusions Among patients with cardiac tamponade, a minority will not have dyspnea, tachycardia, elevated jugular venous pressure, or cardiomegaly on chest radiograph. A pulsus paradoxus greater than 10 mm Hg among patients with a pericardial effusion helps distinguish those with cardiac tamponade from those without. Diagnostic certainty of the presence of tamponade requires additional testing.
El corazón espinado.
A 48-year-old man was referred to our institution because of shortness of breath and symptoms related to right ventricular dysfunction.
His medical history included tuberculosis as a child. Chest radiography showed a calcific ring located at the heart base. Transthoracic echocardiography showed signs of cardiac tamponade. High resolution CT scan showed the calcific ring at the cardiac base reproducing “el corazón espinado” (the sacred heart wrapped in thorns), with incomplete compression at the level of the inferior vena cava. The patient underwent successful pericardectomy (removal of the pericardium). Despite repeated attempts, the diaphragmatic layer of the calcified pericardium was not removed, because of deep penetration of the calcification inside the myocardium of the inferior right and left ventricles. Histology confirmed the tuberculous cause. Chronic calcific pericarditis is an uncommon form of pericardial inflammation. The cause is idiopathic in most cases; tuberculosis is the second most common cause of this syndrome. Pericardial calcifications occur in nearly half the people affected by chronic pericarditis and are often indicative of infective origin. Early pericardiectomy is strongly encouraged in patients suspected of having tuberculous pericarditis with massive calcification, before signs of cardiac tamponade occur.
Source: Lancet
Hydatid pericardial tamponade: a grape soup.
A 35-year-old Libyan woman was referred to us from another institution with the diagnosis of massive pericardial effusion and pericardial tamponade.
On admission to us, she was hypotensive, tachycardic and tachypnoeic. Electrocardiography showed unspecific low QRS voltage and ST-T segment flattening. Chest x-ray showed cardiomegaly. We did an emergency pericardial aspiration which yielded 1500 ml of yellow coloured fluid. A transthoracic echocardiogrm showed multiple cystic formations approximately 1·5—2 cm within the pericardial cavity), and confirmed the need for surgery. We did a standard median sternotomy and thoroughly irrigated the pericardium with hypertonic saline; multiple cysts were removed from the pericardium (figures B and C). Our patient was diagnosed with a ruptured intrapericardial hydatid cyst and pericardial tamponade. We established the diagnosis based on the gross appearance of the removed cysts, the echocardiogram results, and a high ESR. Hydatid disease is endemic in Libya, a southern Mediterranean country. Serological tests were not available. After surgery she was treated with oral albendazole for 12 days. She recovered well and was discharged 12 days after surgery. Pericardial tamponade due to hydatid disease is a rare condition that has been seldom reported in the literature.
Source: Lancet
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