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Beck's triad (較常見於快速積聚的情況下, 慢性則較少見)
- JVE
- HypoTN
- Distant heart sound
Pulsus paradoxus :
吸氣時 SBP 下降超過 10 mmHg
正常情況下，吸氣時血壓會稍微降低，而呼氣時血壓會稍微上升，
下降的正常範圍是 < 10 mmHg，如果下降的幅度 > 10 mmHg 則稱為奇脈
原理 : During inspiration, systolic blood pressure decreases, and pulse rate goes up.
This is because the intrathoracic pressure becomes more negative relative to atmospheric pressure.
This increases systemic venous return, so more blood flows into the right side of the heart.
However, the decrease in intrathoracic pressure also expands the compliant pulmonary vasculature.
This increase in pulmonary capacitance pools the blood in the lungs, and decreases pulmonary venous return, so flow is reduced to the left side of the heart.
Reduced left-heart filling leads to a reduced stroke volume which manifests as a decrease in systolic blood pressure.
The decrease in systolic blood pressure leads to a faster heart rate due to the baroreceptor reflex, which stimulates sympathetic outflow to the heart.)
The cardiac rhythm is regular and there are apparent dropped beats in the peripheral pulse during inspiration.
There is usually a <10 mm Hg decrease in systolic blood pressure during inspiration in the supine position.
A value >10 mm Hg usually separates true tamponade from lesser degrees of restricted cardiac filling.
“Pulsus paradoxus is not diagnostic of cardiac tamponade and may be noted in other cardiopulmonary processes.”
Kussmaul's sign : 吸氣時 JVP 上升 ( 通常吸氣血回右心, JVP 要降 )
EKG :
Diffuse low voltage
Electrical alternans (classic but uncommon finding)
Sinus tachycardia
CXR :
Widen mediastinum waterbag heart
大大的心, 小小的 aorta, 相對乾的 Lung
May be right upper quadrant tenderness from hepatic venous congestion
When clinical signs suggest a hemodynamically significant effusion,
treatment should begin immediately with expansion of intravascular volume
and consideration of the temporary usage of vasoactive drugs if the patient is hypotensive.
Caution should be emphasized in hemopericardium due to aortic dissection where pericardiocentesis has,
in small numbers, been shown to worsen outcomes.
由主動脈剝離引起的心包膜積血, 心包膜穿刺術已被證明在少數情況下會惡化預後, 因此應謹慎評估
Although tamponade can be caused by small effusions,
it is uncommon to see tamponade caused by a small effusion secondary to medical diseases, such as renal failure.
儘管少量積液可能導致填塞, 但由繼發於內科疾病 (如腎功能衰竭) 的少量積液引起填塞的情況並不常見
https://www.youtube.com/watch?v=M4vHEr25yFk
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