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 )
surgical tamponade
Intrapericardial hemorrhage
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