Cardiac Tamponade

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Cardiac Tamponade

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Cardiac tamponade
-DDx includes: Myocardial infarction, heart failure exacerbation, cardiogenic shock, PE, aortic dissection, constrictive pericarditis, cirrhosis, large pleural effusion, and pneumothorax.
-Etiology: Idiopathic, malignancy, uremia, iatrogenic, post-MI, infection, collagen vascular disease, hypothyroidism, or trauma.
-Tamponade due to chest pain, tachycardia, dyspnea, hypotension, JVD, echo & EKG findings.
-Ordered CBC, CMP, BNP, TSH, troponin, ANA tests, ESR, HIV PT/INR, PTT, ECG, CXR, and echocardiogram STAT.
-Admit to cardiac intensive care/telemetry.
-Consult interventional cardiology vs cardiothoracic surgery.
-Supportive care with fluid resuscitation and/or inotropic support, as needed.
-Urgent intervention needed with hemodynamic compromise: catheter pericardiocentesis (relative CI in severe pulmonary HTN and bleeding diathesis/coagulopathy) vs open surgical drainage with or without pericardiectomy (pericardial “window”), or video-assisted thoracoscopic pericardiectomy. Discuss with cardiologist.
-If hemodynamically stable will monitor with serial examination and echocardiogram. 
-Send pericardial fluid analysis for gram stain, bacterial cx, fungal cx, cytology, AFB stain, mycobacterial cx, and PCR, if etiology unclear.
-Monitor for acute LV failure with pulmonary edema, recurrence of effusion, or early constriction.
-Will need repeat echocardiogram prior to discharge.
-Post discharge follow-up echo in 1-2 weeks, then in 6-12 months arranged. 
-Outpatient cardiology and PCP f/u within 7 days of discharge. 
-Poor prognosis.