(1/10) Pericardial tamponade is a clinical diagnosis supported by #echo (2D + quantitative). A 🧵of 10 confirmed tamponade cases (by drainage!) starting with obvious and ending with subtle ones that you could easily miss.. some PEARLS along the way 👇#medtwitter #foamed
(2/10) The swinging heart sign is a strong indicator the a pericardial effusion is hemodynamically important. It also gives the ECG correlate of electrical alternans. #cardiotwitter #echofirst #ecg
(4/10) This large pericardial effusion has fibrin stranding and accumulated sub-acutely (hence large size). Remember, small pericardial effusions can also cause tamponade if they accumulate rapidly (think trauma!) #foamed #medtwitter
(5/10) Although no classic features of tamponade, this effusion caused hypotension with improvement after drainage. One useful (relatively easy) echo marker for tamponade is LVOT VTI - if low (and indicator of low SV), this supports hemodynamic impact of effusion! #echofirst
(6/10) This is a case report we did tinyurl.com of carotid Doppler for monitoring pre-post pericardial effusion drainage 1) VTI variation changed pre-post 2) corrected carotid flow time changed 3) venous signal changed - pericardial effusions cause venous congestion!
(7/10) Tamponade post cardiac surgery is a different beast! Way more likely to be regional, with more subtle findings sometimes (clotted blood is iso-echoic) Here - no obvious pericardial effusion on ME4 view... one might think no tamponade... on the bicaval view however... (see next)
(7/10) Clip # 2 Bicaval view shows large clot adjacent to the RA with tamponade relieved by surgery. Remember to go chamber by chamber to identify extrinsic compression and that clotted blood is more iso-echoic
(8/10) No classic features of tamponade here, however, eventually drained with some hemodynamic improvement. Tamponade is NOT a binary (yes/no) diagnosis -tamponade exists on a spectrum. Also, tamponade can cause organ dysfunction from venous congestion in addition to low SV
(9/10) You can also look for tamponade on TEE - a case where a hypotensive pt. had a moderate sized pericardial effusion and was drained with dramatic improvement in hemodynamics. A great use for #resusTEE @TomJelic @FTeranMD @katiewiskar @uOttawamwoo
(10/10) Finally, another case of regional tamponade post cardiac surgery with clot adjacent to the RV - a subtle presentation that we can't miss! @rudyunni
Case (11-x) - After my 10 cases, its your turn to share your (anonymized) tamponade cases and PEARLS! @ArgaizR @NephroP @TomJelic @dan___kim @Pocus101 @coreultrasound @UltrasoundJelly @zedunow @jeff_sono @PratsEM @srrezaie @BrownJHM @CardioNerds @CardioCrit @IM_Crit_ @johnpeel36 @HoosierPocus @iceman_ex @drshahrul80 @Asiritrauma1
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