Dr.

Muh A Sungkar, SpPD, SpJP

Clinical Features

significant compression of the heart by accumulating pericardial contents ( liquids, pus, blood, clots, and gas singly or combined )
Intrapericardial hemorrhage

surgical tamponade
medical tamponade
low-intensity inflammatory process

SYMPTOMS
Chest discomfort Tachypnea Dyspnea on exertion Orthopnea Cough and dysphagia Weak and anorectic Feeling faint to having syncope Anemia Weakness Complication : renal failure; abdominal plethora mesenteric ischemia. or hepatic (shock liver)

PHYSICAL FINDINGS
Tachycardia Heart sounds may be distant Relative accentuation of the pulmonic component of S2 Precordium may be quiet and an apex beat not palpable Significant tamponade produces absolute or Relative hypotension Cool extremities, nose, and ears, sometimes with acral cyanosis Central cyanosis : right-to-left shunt Fever Jugular venous distention Peripheral venous distention: forehead, scalp, and ocular fundi Kussmaul sign Pulsus Paradoxus

DIAGNOSIS
Hypotension and the following findings Elevated systemic venous pressure Falling blood pressure Pulsus paradoxus Tachycardia Dyspnea or tachypnea whit clear lungs chest and abdominal wounds Anticoagulant or thrombolytic therapy Drugs such as cyclosporine Recent cardiac surgery Blunt chest trauma Malignancies Connective tissue disease Renal failure Septicemia

Cardiac tamponade

Physiology of pulsus paradoxus

Cardiac tamponade and compensatory mechanisms

Pericardial tamponade: hemodynamics

Pericardial effusion with tamponade: ECG findings

Pericardial effusion with tamponade: chest radiograph

Large pericardial effusion with tamponade. Biatrial (RA and LA) collapse (arrows).

Large pericardial effusion (PE) with tamponade. Arrow indicates right ventricular (RV) collapse

Pericardial effusion with tamponade: echocardiogram

Treatment
MEDICAL TREATMENT PERICARDIAL DRAINAGE SURGICAL DRAINAGE