0071643192.pdf

CARDIOVASCULAR EMERGENCIES

Beck’s triad (tamponade):

Hypotension

JVD

Muffled heart sounds

Kussmaul’s sign—-may also be

seen with restrictive

cardiomyopathy and

constrictive pericarditis.

Electrical alternans =

tamponade until proven

otherwise.

ECHO confirmation of

tamponade=RV collapse

during diastole.

ETIOLGIES

Most common etiologies of pericardial effusion:

■ Trauma

■ Pericarditis

■ Renal failure

SYMPTOMS/EXAM

■ Nonspecific symptoms are common (fatigue, chest pain, dyspnea).

■ Cardiovascular collapse may occur if rapidly developing (eg, traumatic

effusion).

■ Beck’s triadis classic for tamponade.

■ Hypotension

■ Jugular venous distention (JVD)

■ Muffled heart sounds

■ Pericardial friction rub

■ Tachycardia

■ Narrowed pulse pressure

■ Kussmaul’s sign= in jugular venous pressure during inspiration

■ Pulsus paradoxus =inspiratory reduction in systolic pressure of >10 mmHg

DIAGNOSIS

■ Suspect based on history and physical examination

■ ECG

■ Low QRS voltage =nonspecific

■ Electrical alternans=variation of height of the QRS complexes as a

result of the heart swinging within the pericardial effusion

■ Echocardiogram—diagnostic study of choice

■ Tamponade physiology represented by R ventricular collapse during

diastole

■ Sniff test →lack of proximal IVC collapse with quick breath in through

nose (“sniff”)

■ Magnitude of the effusion can be evaluated.

TREATMENT

■ No tamponade physiology

■ Supplemental O 2

■ Volume resuscitation to improve left ventricular filling pressures

■ Immediate cardiothoracic surgery or cardiology consult

■ Prepare for pericardiocentesis.

■ Pericardial tamponade →immediate pericardiocentesis

A 25-year-old male presents with flu-like symptoms, chest pain, and worsen-

ing shortness of breath. He has no past medical history, but recently returned

from a 2-week camping trip to Central America. On examination, the patient

has bilateral rales, S3, and jugular venous distention. His ECG shows tachycardia

and nonspecific T-wave changes. Echocardiogram shows diffuse hypokinesis. What

is the most likely etiologic agent in this patient?

This patient likely has myocarditis from the parasite Trypanasoma cruzi. Chagas

disease, which results from infection withTrypanasoma cruzi, is the most common

etiology of myocarditis worldwide. It is especially common in Latin America.

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