Question
A patient suffers from shortness of breath, weakness, lightheadedness, and cough 24 hours after a heart surgery.ECG shows the following features.What can be the most probable diagnosis?
A. Myocardial Infarction.
B. Complete Heart Block.
C. Myocardial Ischemia.
D. Cardiac Tamponade.
Show Answer
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Correct Answer » D
Explanation
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Ans: D. Cardiac Tamponade.
ECG in the image shows: Electrical alternans as seen by changing QRS amplitudes best seen in lead II ,it is suggestive of Cardiac Tamponade.
Cardiac tamponade.
- It is when fluid in the pericardium (the sac around the heart) builds up and results in compression of the heart.
Symptoms:
- typically include those of cardiogenic shock including shortness of breath, weakness, lightheadedness, and cough.
Cause:
- Cardiac tamponade is caused by a large or uncontrolled pericardial effusion, i.e. the buildup of fluid inside the pericardium.
- This commonly occurs as a result of chest trauma (both blunt and penetrating), but can also be caused by myocardial rupture, cancer, uremia, pericarditis, or cardiac surgery,retrograde aortic dissection
Diagnosis:
- It may be suspected based on low blood pressure, jugular venous distension, pericardial rub, or quiet heart sounds.
- The diagnosis may be further supported by specific electrocardiogram (ECG) changes, chest X-ray, or Echocardiography
ECG findings shows a triad of:
- Low QRS voltage
- Tachycardia
- Electrical alternans.
- Electrical alternans occurs when consecutive, normally-conducted QRS complexes alternate in height.
- the heart swings backwards and forwards within a large fluid-filled pericardium.
Treatment:
- When tamponade results in symptoms, drainage is necessary.
- This can be done by pericardiocentesis, surgery to create a pericardial window, or a pericardiectomy
