Cardiac Tamponade
Physical findings & Clinical Presentation:
• Severeconstant pleuritic pain that localizes over the anterior chest and may radiateto arms and back; it is differentiated from myocardial ischemia, becausethe pain intensifies with inspiration and is relieved by sittingup and leaning forward.
• Pericardial friction rub is best heard with patientupright and leaningforward and by pressing the stethoscope firmly against the chest; itconsists of three short, scratchy sounds:
• Signs and symptoms:
- Dyspnea
- Orthopnea
- Interscapular pain
- Tachycardia
- Refractary hypotension
- Distended neck veins
- Paradoxicalpulse
- Chest x-ray: Cardiomegaly, clear lungs (may be normal)
- ECG: Low amplitude of QRS, electrical alternans
Treatment:
Immediatepericardiocentesispreferably by needle paracentesis with the use of echocardiography, fluoroscopy,orCT Aspirated fluidshould be sent for analysis (protein, LDH, cytology, CBC, Gram stain, AFBstain) and cultures for AFB, fungi, and bacterial C&S.
Cardiac Tamponade
Cardiac Tamponade
Regards,
Jon Mikel Iñarritu, M.D.
technorati tags: cardiac tamponade, CXR, x-ray, xray, medical images, clinical cases, emergency procedures, pericardiocentesis, ecocardiography, unbounded medicine, medicine
