CARDIAC-TAMPONADE

A review is presented of cardiac tamponade, both acute and subacute, its pathophysiology, etiology, clinical diagnosis, complementary diagnostic studies and management. Typical hemodynamic evidences are elevated central and systemic venous pressure, tachycardia, decrease in left ventricular end-diastolic volume, increase in left ventricular ejection fraction and stroke volume, and a rise in systemic vascular resistance. The most common causes are trauma, neoplasm, dissecting aorta, myocardial infarction and infection. The symptoms are usually not diagnostic. Paradoxical pulse and high central venous pressure are important and virtually always present. Echocardiography is the most reliable, and convenient method for detecting pericardial effusion. The essential step in management is relieving the compression of the heart by removing fluid either by pericardiocentesis or surgical means. Advantages and disadvantages of both methods are commented. In emergency circumstances, supportive therapy including intravenous fluids, and drugs to increase central venous pressure, promoting filling of the heart and maintaining cardiac output, are very helpful. (E. Mattar - Sao Paulo - Brasil)