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Common Congenital Heart Lesions - page 76 / 126





76 / 126

76 of 126

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      Patient is head up at 45 deg angle, needle inserted into pericardial space below xiphoid process… catheter inserted into pericardial space and another catheter into right side of heart… both hooked up to a transducer for pressure readings

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        In tamponade, intrapericardial and diastolic intracardiac pressures will be high and equal… after pericardiocentesis, pericardial pressure goes to normal and is no longer equal to pressures w/in heart (which also decline to normal levels)

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        Can repeat procedure if tamponade recurs

  • Sometimes you may need to remove part or all of the pericardium (surgery) to prevent reoccurances…

Constrictive Pericarditis

Doesn’t happen too often, but important b/c it can masquerade as other common disorders… also, it’s really bad, but correctable – like tamponade.


  • Used to be TB, but that’s not common anymore, so now most freq cause is idiopathic Æ months to yrs after an idiopathic/viral acute pericarditis… but any pericarditis can lead to this


  • Normally, after an acute pericarditis, the effusion usually gets gradually resorbed…

  • In constrictive pericarditis, the fluid undergoes organization and fuses with the pericardial layers and later forms scars… sometimes you also get calcification…

  • So now a rigid, scarred pericardium encircles the heart and inhibits normal filling of the cardiac chambers… the abnormalities occur during diastole; systolic contraction of the ventricles are normal

  • During diastole, blood goes from RA Æ RV and RV size expands and quickly reaches its limit imposed by the hard pericardium… at this pt, further filling is abruptly stopped and venous return to the right heart stops.

  • Thus, systemic venous pressure rises (R-sided heart failure systems) and also since the LV is impaired as well, you get decr SV Æ decr CO Æ decr BP

  • The way I see it, to understand the physical difference b/c tamponade and constrictive pericarditis, think of the heart up against a big water balloon that is pushing on the chambers not letting them fill as much… that’s tamponade. Now think of the heart in a very small, hard, container… the heart will fill in the beginning just fine but only until it reaches the confines of the container… then no more… that’s constrictive pericarditis.


  • Signs and symptoms develop over months to years

  • Often resemble symptoms of tamponade

  • Reduced CO

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