ETIOLOGIES Same as pericarditis. Always rule out ACS in a patient presenting with classical signs of pericarditis.
CLINICAL FINDINGS
Same as pericarditis, but alterations in vital signs may be more pronounced and shock state may exist. Often asymptomatic when small. Beck’s triad for cardiac tamponade.
DIAGNOSIS
Cardiovascular Emergencies
HIGH-YIELD FACTS
Cardiac tamponade is one of the causes of pulseless electrical activity (PEA).
CXR: Cardiomegaly (see Figure 8-19). ECG: Differing QRS amplitudes (“alternans,” Figure 8-20) and axes caused by ventricle swaying within fluid-filled pericardial sac with each beat. Echocardiography: Effusion, decreased systolic and diastolic function, collapse of right ventricular/right atrial free walls in diastole.
TREATMENT
Beck’s triad: Hypotension JVD Muffled heart sounds
ABCs, IV, O2, monitor. Pericardiocentesis immediately if hemodynamically unstable or pulseless (see Procedures chapter). If more stable, a pericardial window can be created in the operating room (OR) to prevent reaccumulation of effusion.
FIGURE 8-19.
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CXR demonstrating cardiomegaly secondary to pericardial effusion.