(Cardiac Tamponade)

(cardiac tamponade)

(cardiac tamponade) ( )

(ventricular diastolic filling)
(cardiac output)

15-30 .

80-200
. 200 .

1
(stiff) (fibrosis)

(pericardial effusion) 1

1 (pericardial effusion)1,3
(idiopathic pericarditis)

/

(primary)
Nephrotic syndrome
Mesothelioma, teratoma, fibroma,

, sarcoma, leukemia
(metastasis)
Breast carcinoma, bronchogenic carcinoma,
lumphoma, melanoma, etc.

Coxsackie, echovirus, infectious
mononucleosis, HIV

Histoplasmosis, aspergillosis, etc.

Mycobacterium tuberculosis,
Staphylococcus, Streptococcus,
Burkholderia (Pseudomonas) pseudomallei,
bacterial endocarditis, etc.

Uremia, myxedema (hypothyroidism),

hypoalbuminemia

(radiation)
Dissecting thoracic aortic aneurysm
(trauma)
Pericardiotomy
Indirect trauma

(catheter)
(acute MI)
Delayed postmyocardial-pericardial injury
Post-MI (Dresslers syndrome)
Postpericardiotomy syndrome
Immunologic/ Inflammatory disorders
Rheumatic fever, SLE, ankylosing apondylitis,
rheumatoid arthritis, vasculitis, etc.

Procainamide, hydralazine, heparin, warfarin,

phenytoin, phenylbutazone, etc.

Topol EJ, Klein AL, Scalia GM. Disease if the pericardium, restrictive cardiomyopathy, and diastolic
dysfunction. In: Topol EJ, editor. Comprehensive cardiovascular medicine. Philadelphia: Lippincott Williams & Wilkins;
1998. p. 669-733.

(muffled heart sounds) (jugular vein)
prominent x descent y descent
isolated left atrial tamponade
Paradoxical pulse (systolic BP) 10 .

Kussmauls sign (jugular vein)

, right ventricular infarction

Ewarts sign bronchial breath sounds egophony

rales


low voltage QRS complex T-waves
electrical alternans ( 4)

(cardiac silhouette)
250 . 5 (globular water bottle-shaped
heart) ( 5) parietal pericardium

epicardial
fat ( 1-2 .) (pulmonary congestion)

hilar overlay sign

(transthoracic echocardiography)

pericardial sac
(diastolic phase) right atrial right ventricle collapse left atrial collapse
(swinging heart)1
(MRI) (CT scan)
loculated effusion
mediastinum
(right-heart catheterization)
hemodynamic
(pericardiocentesis)


4 electrical alternans QRS complex
( )

 5 massive pericardial effusion globular

water bottle-shaped heart hilar overlay sign ()

pericardiocentesis (resuscitation)
(volume expanding agents) 0.9% normal saline RV

diastolic collapse norepinephrine (levophed)

(pericardiocentesis)
(indications)
1.
2. (open heart
surgery)
(Contraindications)
absolute
relative contraindications 6
1. (anticoagulant)
prothrombin time (PT) partial thromboplastin time (PTT) PT INR 1.8
PTT 2 fresh frozen plasma
2. (thrombocytopenia) 50,000
3. Traumatic hemopericardium
4. Type A aortic dissection
(10-25 .) stabilized
5. Subacute free wall rupture dissections free wall rupture

6. Small posteriorly located effusion
echocardiogram
7. Purulent effusion
8. Malignant effusion
(recurrent)
(pericardial window)

(echo-guided)6
(echocardiography)
(left lateral decubitus) 30

echocardiography

probe
(permanent
markers) sterile providine iodine solution

(1% lidocaine) (superior
aspect) intercostal artery
18-gauge
3 (three-way stopcock) (syringe) (sterile
hemostate) ( pericardium )
probe
(0.035- guidewire)


(6-Fr dilator)

(6-Fr 8-Fr pigtail catheter)

3 2
30 . (vacuum bottle) (drainage bag)
(syringe)
(EKG-guided)6

(subxyphoid approach)
1. 45
2. EKG limb leads
3. (subxyphoid approach)
process
4. 25-gauge
5. 21-gauge 10
(sterile alligator clip)
V lead
6. 30
( 6) (costal margin)

7. ST elevation ( 7)
premature ventricular contractions PR
elevation PACs right atrium
6-8 .

8.

6 (subxyphoid approach)

7
ST elevation

1. mycobacterium
2. (cytologic examination)
3. acid-fast bacillus
4. (cell count) (protein) lactate
dehydrogenase (LDH)
5. complete blood count (CBC), blood chemistry, titers
cytomegalovirus, coxsackie B virus, antinuclear antibody, rheumatoid titer




Pneumothorax
Chamber entry /cardiac laceration



Arterial laceration left internal mammary artery (
5 . ) posterior descending artery intercostal arteries
(superior)
Infection


(pneumothorax)
1-2
(antibiotic ointment) 2-3
6
sterile saline

50 ./


(pericardial pain) nonsteroidal analgesics

1. Stein AB, Crawford PA. Disease of the pericardium. In: Crawford PA, Lin TL, eds. The
Washington manual subspecialty consult series: Cardiology subspecialty consult. Philadelphia:
Lippincott Williams & Wilkins; 2004. p. 200-7.
2. Gokdstein JA. Cardiac tamponade, constrictive pericarditis, and restrictive cardiomyopathy.
Curr Probl Cardiol 2004; 29: 503-67.
3. Topol EJ, Klein AL, Scalia GM. Disease if the pericardium, restrictive cardiomyopathy, and
diastolic dysfunction. In: Topol EJ, editor. Comprehensive cardiovascular medicine.
Philadelphia: Lippincott Williams & Wilkins; 1998. p. 669-733.
4. Beck C. Two cardiac compression triads. JAMA 1935;104:714-6.
5. Reginelli JP, Wu J, Chetcutti S. Pericardial disease. In: Griffin BP, Topol EJ, eds. Manual of
cardiovascular medicine. Philadelphia: Lippincott Williams & Wilkins; 2004. p.372-96.
6. Gring C, Griffin BP. Pericardiocentesis. In: Griffin BP, Topol EJ, eds. Manual of cardiovascular
medicine. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 709-13.