#1: What
is your diagnosis?
#2: Explain
the echocardiographic signs that you would expect with this
diagnosis?
Explanation:
The patient has a pericardial clot causing tamponade.
Signs of tamponade depend upon the pericardial sac and the type of pericardial fluid. In an intact pericardium, an acute rise in volume can quickly cause tamponade without much volume. However, in chronic effusions, tamponade may occur with several liters of fluid in the pericardium where the pericardium has had time to enlarge. In the patient with an intact pericardium, the pressure in the pericardium rises and in transmitted to the lower pressure chambers of the heart - the atria. The atria become collapsed and the preload to the heart is decreased despite high filling pressure to the atria (CVP). As the pressure increases more the right ventricle is the first ventricle to be affected. If the pressure exceeds the diastolic right ventricular pressure the RV collapses during diastole (diastolic collapse) and eventually, with more increased pericardial pressure the right ventricle fails to fill during systole and diastole.
Post-op CABG patients do not have an intact pericardium. Fluid or blood must collect around the heart to affect the chambers. Fluid pressure is transmitter throughout the chest, whereas, clots will push on adjacent structure - their pressure is more localized and directed to nearby structures. If a clot is by the left atrium, the left atrium will be affected first. If the pressure exerted exceeds the atrial filling pressure, the atria become collapsed. Similarly, the ventricles become affected.
In this video the clot is pushing on the right atrium and right ventricle, inhibiting the filling of those chambers. Since the filling is compromised, the ejection is compromised also. The left atrium and ventricle are hypovolemic and the video shows a small left ventricular cavity that is foreshortened. A clot also exists around the apex of the heart.
Signs of tamponade depend upon the pericardial sac and the type of pericardial fluid. In an intact pericardium, an acute rise in volume can quickly cause tamponade without much volume. However, in chronic effusions, tamponade may occur with several liters of fluid in the pericardium where the pericardium has had time to enlarge. In the patient with an intact pericardium, the pressure in the pericardium rises and in transmitted to the lower pressure chambers of the heart - the atria. The atria become collapsed and the preload to the heart is decreased despite high filling pressure to the atria (CVP). As the pressure increases more the right ventricle is the first ventricle to be affected. If the pressure exceeds the diastolic right ventricular pressure the RV collapses during diastole (diastolic collapse) and eventually, with more increased pericardial pressure the right ventricle fails to fill during systole and diastole.
Post-op CABG patients do not have an intact pericardium. Fluid or blood must collect around the heart to affect the chambers. Fluid pressure is transmitter throughout the chest, whereas, clots will push on adjacent structure - their pressure is more localized and directed to nearby structures. If a clot is by the left atrium, the left atrium will be affected first. If the pressure exerted exceeds the atrial filling pressure, the atria become collapsed. Similarly, the ventricles become affected.
In this video the clot is pushing on the right atrium and right ventricle, inhibiting the filling of those chambers. Since the filling is compromised, the ejection is compromised also. The left atrium and ventricle are hypovolemic and the video shows a small left ventricular cavity that is foreshortened. A clot also exists around the apex of the heart.
Aucun commentaire:
Enregistrer un commentaire