Flashcards in Cardiovascular Emergencies Deck (19):
What is the etiology of Cardiac tamponade?
Occurs when arterial, ventricular, or atrial injury causes blood to leak into the pericardium. (Effusion or hemorrhage into the pericardium). The increased pressure compresses the heart and decreases cardiac output, in addition to decreasing venous return and cardiac filling.
Most oftenly associated with penetrating injuries.
How does a patient present with Cardiac tamponade?
Dyspnea, chest discomfort, edema, easy fatigability, Kussmal's breathing.
What are the physical findings in association with Cardiac tamponade?
Tachycardia, elevated JVP, pulsus paradoxus, pericardial rub. This can ultimately lead to shock and death!
How do we evaluate a patient with Cardiac tamponade?
Echo is the best, can also get an EKG. Diagnose with bedside focused assessment with sonography for trauma (FAST) in ED. Highly sensitive and specific.
Cardiac tamponade EKG findings
Sinus tachycardia, electrical alterans, low voltage
Cardiac tamponade CXR findings
Large cardiac silhouette, not always helpful
Cardiac tamponade Echo findings
How do we treat Cardiac tamponade?
Definitive treatment is the removal of fluid. Pericardiocentesis vs. open surgical drainage. If unstable need to do an immediate thoracotomy.
Complications with Cardiac tamponade:
Avoid using general anesthesia. It can results in severe hypotension.
What are the types of Angina?
Stable, Unstable and Variant
By definition, pattern of discomfort, frequency of occurrence, and precipitating factors have remained the same for > 3 mo. Usually precipitated by activity or emotion, relieved by rest or nitroglycerin.
FIXED Coronary Obstruction
Any change in the stable angina pattern, brand new angina or angina occurring at rest. Precipitated by a lesser degree of activity and may respond less to nitroglycerin.
Angina at rest is most serious form!
Non-specific pattern, secondary to vasospasm rather than atherosclerotic narrowing of the vessels. Sudden and reversible, severe coronary artery obstruction.
This discomfort lasts longer than stable angina and is often accompanied with EKG ST segment elevation that is transient and reversed in minutes after administration of nirtoglycerin.
Stable Angina Treatment
Nitroglycerin. Pain is usually relieved in 1-2 minutes.
Unstable, Rest, and Variant Angina Treatment:
MONAB. O2 is given via mask or cannula. Hospitalize the patient immediatley. Can also give anticoagulation.
Ca+ blockers are used for long term treatment of patients with variant angina!
Results from an imbalance between myocardial oxygen supply and demand.
Diminished coronary perfusion; insufficient to meet myocardial oxygen demand.
Pathophysiology of Ischemia
1. Fixed atherosclerotic narrowing of the coronary arteries.
2. Intre-coronary thrombosis overlying a disrupted atherosclerotic plaque.
3. Platelet aggregation.
4. Vasospasm of the artery.