If you have cardiace tamponade from a lesion in your LV

[Sarahgelatinano]

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For the cadiologists out there, please help!

If you have cardiace tamponade from a lesion in your LV (due to previous MI), would your pulm. cap. wedge pressure be high or low?

My thoughts.....

Since you have a leakage in your LV, then LV pressure falls, as does LA and the pulm. system. Because we now have a cardiac tamponade and HUGE pressure around the heart, this is stopping venous return, thus lowering the volume of blood in the heart proper. Lower volume equals lower pressure. So I think it would lower the PCWP.

My colleagues and I are in a big argument over this. Their thinking is that even though you have the leak into the pericardial sac, this is not enough volume to lower the pressure of the heart. Thus, the increased pressure from the cardiac tamponade would increase pressure in the LV and back that all the way up to the pulm. caps, where the wedge pressure would read higher.

Any insight to the heart experts out there?

Thank you in advanced!

 

[Gharfunkle]

The word tamponade is defined by "equalization of pressures" among the various heart chambers. Echocardiographically, this will be apparent with right-ventricular collapse during diastole, resulting in poor right-sided filling pressures, and thus reduced cardiac output. You are absolutely correct that this equalization of pressures, or tamponade, phenomenon will result in diminished venous return. This is essentially the pathogenesis of tamponade. The physiology of tamponade applies regardless of the source of pericardial fluid, LV, RV, inflammatory, or malignant. That being said, LV free-wall rupture is an extremely morbid complication from a myocardial infarction and it would be lucky to even get the person to the OR in time to repair it, so the debate on the physiology, from the clinical standpoint, is academic.

 

[RS8]

Hi,
I am interested in getting more details on what would cause a cardiac tamponade due to aortic dissection case ?

here is the situation -

-cardiac tamponade(550 ml blood) due to thoracic aortic dissection
-14 cm aortic dissertation , heart weight 350gm


1. What might trigger this situation ? In other words what would cause the fluid/blood to move between Parietal and visceral pericardium ?

A. Can hypertension/ high HDL / LDL be the catalyst ?
B. Cold temperature can effect (about 50-55 Fahrenheit )?
C. Any past accident or if someone punched on the chest very hard might be the culprit ?
D. I don't think Tamponade can kill someone in very short time, how much time it may take from the time Tamponade started to the time when the person may die.(or around 550 ml blood can accumulate in the sac)
E. It may cause sudden death without any chest/back pain or other symptoms in past ? if not, at-least what symptom should occur (other then last tearing pain in chest, that killed the person)?
F. Extra pressure while on toilet/motion(with constipation) can trigger it ?
G: Cardiac Tamponade may happen due to the initial life saving steps performed by the emergency/ambulance team? and actual reason might be something else for the death?

2. Is there any relation between Cardiac Tamponade and paralysis or arthritis
3. or it could be genetic (could it be a genetic cause/link - dextrocardia in grand child and cardiac tamponade in grand mother?)

Any pointers would be much appreciated.

 

[Instatewaiter]

Hi,
I am interested in getting more details on what would cause a cardiac tamponade due to aortic dissection case ?

here is the situation -
-cardiac tamponade(550 ml blood) due to thoracic aortic dissection
-14 cm aortic dissertation , heart weight 350gm

1. What might trigger this situation ? In other words what would cause the fluid/blood to move between Parietal and visceral pericardium ?

A. Can hypertension/ high HDL / LDL be the catalyst ?
B. Cold temperature can effect (about 50-55 Fahrenheit )?
C. Any past accident or if someone punched on the chest very hard might be the culprit ?
D. I don't think Tamponade can kill someone in very short time, how much time it may take from the time Tamponade started to the time when the person may die.(or around 550 ml blood can accumulate in the sac)
E. It may cause sudden death without any chest/back pain or other symptoms in past ? if not, at-least what symptom should occur (other then last tearing pain in chest, that killed the person)?
F. Extra pressure while on toilet/motion(with constipation) can trigger it ?
G: Cardiac Tamponade may happen due to the initial life saving steps performed by the emergency/ambulance team? and actual reason might be something else for the death?

2. Is there any relation between Cardiac Tamponade and paralysis or arthritis
3. or it could be genetic (could it be a genetic cause/link - dextrocardia in grand child and cardiac tamponade in grand mother?)

Any pointers would be much appreciated.

Tamponade is determined not by the volume of blood but the rate of accumulation. You can go into tamponade with a 100-150cc of rapidly accumulated fluid. Other times, with slow accumulation, a patient won't be in tamponade with 1 liter of fluid.

1) Dissection through the valve into the pericardium.
a) Yes, when mixed with poorly controlled HTN
b) unlikely without concomitant underlying issues
c) Not sure if you are asking a question here or really what the question is
d) Very, very wrong. If you rupture your LV or dissect directly into the pericardium, the patient will crump incredibly quickly and die. You won't be able to get them out the door before you're coding them.
e) In my experience, type A dissections are rarely clinically silent. I have seen one type A dissection found incidentally and even then the patient had CP but never put two and two together.
f) yes
g) What?

2) Do your own homework

3) Marfan and other genetic collagen vascular disease.

 

[keindo]

Hi,
I am interested in getting more details on what would cause a cardiac tamponade due to aortic dissection case ?

here is the situation -
-cardiac tamponade(550 ml blood) due to thoracic aortic dissection
-14 cm aortic dissertation , heart weight 350gm

1. What might trigger this situation ? In other words what would cause the fluid/blood to move between Parietal and visceral pericardium ?

A. Can hypertension/ high HDL / LDL be the catalyst ?
B. Cold temperature can effect (about 50-55 Fahrenheit )?
C. Any past accident or if someone punched on the chest very hard might be the culprit ?
D. I don't think Tamponade can kill someone in very short time, how much time it may take from the time Tamponade started to the time when the person may die.(or around 550 ml blood can accumulate in the sac)
E. It may cause sudden death without any chest/back pain or other symptoms in past ? if not, at-least what symptom should occur (other then last tearing pain in chest, that killed the person)?
F. Extra pressure while on toilet/motion(with constipation) can trigger it ?
G: Cardiac Tamponade may happen due to the initial life saving steps performed by the emergency/ambulance team? and actual reason might be something else for the death?

2. Is there any relation between Cardiac Tamponade and paralysis or arthritis
3. or it could be genetic (could it be a genetic cause/link - dextrocardia in grand child and cardiac tamponade in grand mother?)

Any pointers would be much appreciated.

That size font almost gave me an aortic dissection.