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Guess the Diagnosis: Low blood pressure, elevated heart rate, & pericardial effusion


OVERVIEW ABOUT PATIENT:

A patient suddenly becomes hypotensive at 76/53. The patient also complains of shortness of air and chest pain. The patient’s chest Xray shows an enlarged cardiac silhouette. The patient’s jugular venous pressure is also elevated. You notice that the patient also has some venous distention on their forehead. Upon auscultation, their heart sounds muted/distant. Their extremities are cool and are starting to turn cyanotic.

The patient is rushed to have a transthoracic echocardiogram done. The test results show a large amount of pericardial effusion and also chamber collapse. The patient’s cardiac enzymes are also mildly elevated.



GUESS THIS DIAGNOSIS


ANSWER

Cardiac Tamponade

DIFFERENTIAL DIAGNOSIS: Restrictive cardiomyopathy, cardiogenic shock

WHAT IS IT: Considered a medical emergency. When fluid, air, blood or pus accumulates within the pericardium. The pericardium is the membrane enclosing the heart. The pericardium is usually able to stretch (as it is elastic), to accommodate variations in cardiac volume (3). But when its maximum is reached-this can lead to cardiac tamponade. Cardiac tamponade basically compresses the heart.

LABS: Cardiac enzymes might be elevated. SED rate likely elevated- but is a nonspecific test for this diagnosis. WBC sometimes elevated. Low hgb might be seen.

DX TESTS: Transthoracic echocardiogram usually shows large pericardial effusion, chamber collapse, and respiratory variation of ventricular filling (3). A chest X-ray usually shows an enlarged cardiac silhouette. An EKG-low voltage is often seen.

S/S: Tachycardia, hypotension (common), distant/muted heart sounds, elevated jugular venous pressure, may hear pericardial rub, venous distention in forehead and scalp sometimes seen, pulsus paradoxus

RISK: Myocardial infarction, pericarditis, dissecting aortic aneurysm, heart surgery, end stage lung disease, wounds to the heart, TB

TREATMENT: Emergent pericardiocentesis or surgical drainage of pericardium. If hemodynamically stable (SBP >110) and pre-tamponade, sometimes anti-inflammatory medications, such as NSAIDS, are used (in combination with PPI for gastric protection).

REFERENCE:

  1. Pictures Credit: Pixabay
  2. Cardiac Tamponade Epocrates:I highly recommend signing up for Epocrates. There is a free (drugs) and a paid version- runs anywhere from 150-180 per year-but so worth it! I have been using it for years and years and couldn’t go without it! I use it more than any other medical app.
  3. Cardiac Tamponade Up to date
  4. Medline plus
DISCLAIMER: The information posted is not intended to be medical advice. This is for educational purposes only. This information is intended for medical professionals & students. All patients should ALWAYS check with their primary care provider with any questions regarding their health. This is not intended to guide in medical decisions or treatment in any way. As always, medical professionals should call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly. Med Made Ez (MME) disclaims any liability for the decisions you make based on this information.

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