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Common Congenital Heart Lesions - page 75 / 126

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75 / 126

75 of 126

TESTS and IMAGING

Echocardiography Æ most

useful

noninvasive

tech. Evaluate whether effusion led to

tamponade… important indicator of high pressure fluid is compression of RV and RA during diastole (good pic of what echo image will look like on pg 56 – fig 3.12)… echo can

differentiate b/t tamponade and other causes of low CO

Cardiac catheterization Æ definitive diagnostic procedure. Measures intracardiac and intrapericardial pressures… (below is a measure of RA pressures)

  • o

    In early diastole (the dotted line), normally, the tricuspid opens and there is a rapid decline (the y descent) in RA pressure as blood flows into the RV… in cardiac tamponade, the pericardial fluid is pushing on the RV during diastole, so it can’t fill as easily, so the RA can’t empty as quickly, and thus, the y descent is blunted in cardiac tamponade.

  • Can also do a pericardiocentises along with the catheterization…and after pericardiocentises, you’ll want to keep some pericardial fluid for diagnostic purposes Æ stain for bacteria, fungi… get cell counts… protein levels… adenosine deaminase levels (high levels are sens and spec for TB)

TREATMENT

  • Pericardiocentises is the only intervention that can save the patient’s life.

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