Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1154 Peptic Ulcer Disease Pericardial Tamponade

■Maintenance therapy with an H2RA or PPI decreases relapse rate to

10–15%

■Of those infected with and cured of theirH. pylorionly 20% will still

have an ulcer relapse

■Patients developing an ulcer while on NSAIDs

➣NSAIDs are relatively contraindicated in future

➣If NSAID is absolutely needed (which should be a rare event) use

Co-therapy with PPI or misoprostol

A COX-2 sparing agent

PERICARDIAL TAMPONADE

ANDREW D. MICHAELS, MD

history & physical

Signs & Symptoms

■lightheadedness

■dyspnea

■tachycardia, hypotension

■elevated neck veins

■pulsus paradoxus

■clear lung fields

tests

ECG

■low QRS voltage

Chest x-ray

■enlarged cardiac silhouette

Echo

■diastolic collapse of right atrium/ventricle

■respiratory variation in tricuspid/mitral inflow velocities

■dilated inferior vena cava

differential diagnosis

■consider other causes of hypotension (hypovolemia, sepsis, MI, ten-

sion pneumothorax, aortic dissection, CHF)

management

■emergent pericardiocentesis is treatment of choice