Diagnosis and management of cardiac tamponade in the era of echocardiography

Abstract

Summary: Cardiac tamponade is a life-threatening condition. Accurate diagnosis and prompt intervention are necessary. Classically, clinical features of tamponade include pulsus paradoxus, tachycardia, increased jugular venous pressure, and hypotension. With the advent of echocardiography, confirmation of an effusion and accurate assessment of its hemodynamic impact can be achieved, frequently in the absence of overt clinical manifestations. The decision regarding treatment and timing of intervention must take into account the clinical presentation and echocardiographic findings, along with careful weighing of risks and benefits to the individual patient. Echocardiographically guided pericardiocentesis is the best available therapy for initial management of cardiac tamponade. It is simple, safe, and effective for removing pericardial fluid and reversing hemodynamic instability, and the use of a pericardial catheter for extended drainage has been associated with significant reduction in recurrence of fluid accumulation.

Robot-Assisted Pericardial Drainage

“…Assessment of patient with PE includes chest X-ray, transthoracic echocardiography, computerized tomography and eventually invasive techniques [11,12]. Various techniques have been described for the diagnostic and also therapeutic management of PE, which includes ultrasound-guided pericardiocentesis [12][13][14], catheter drainage [4,11,15], pericardioperitoneal shunt [16][17][18], pericardial fenestration/window [3,7,19]. The size and duration of fluid accumulation in pericardial space are the key points for management.…”

Oncologic emergencies: a review

“…A catheter left in situ for continuous drainage is ideal as the effusion is very likely to recur. 28 Video-assisted thoracoscopic (VATS) pericardial window is another safe and highly effective surgical alternative. 29 Intrapericardial administration of chemotherapeutics such as bleomycin, carboplatin, or mitomycin-C found to be safe in chemosensitive tumours.…”

Transesophageal Echocardiography for the Noncardiac Surgical Patient

“…Because the management of MI, pulmonary embolism, hypovolemia, or obstruction is fundamentally different, the early placement of TEE can significantly assist in forming and optimize the treatment plan. 4,11,12 Case examples…”

“…Traumatic injuries can be examined and TEE information can help with surgical decisions (thoracic aortic dissection, cardiac tamponade, tension pneumothorax, myocardial contusion). 12,13 However, because the stability of the cervical spine is commonly still in question when the trauma patient is taken to the operating room, the placement of the TEE probe must be done as carefully as possible (see Table 4 on Contraindications). In addition, it should be remembered that all ''trauma patients'' are considered to have high gastric volumes (''full stomach'') and therefore are at higher risk for viscous rupture.…”