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Essential Features

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  • • Inadequate perfusion

    • Compression of the heart or great veins

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Epidemiology

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  • • Pericardial tamponade

    • Tension pneumothorax

    • Abdominal compartment syndrome

    • Diaphragmatic rupture with abdominal viscera in chest

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Clinical Findings

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Symptoms and Signs

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  • • Distended neck veins

    • Postural hypotension

    • Oliguria

    • Sweating

    • Mental status changes

    Kussmaul sign: Distention of neck veins with deep inspiration is pathognomonic of pericardial tamponade

    Paradoxic pulse: A fall of > 10 mm Hg with inspiration supports diagnosis

    • Equalization of heart chamber pressures with pulmonary artery catheter placement

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Diagnostic Considerations

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  • • Mechanism of injury often raises suspicion

    • Decision must sometimes be made for intervention without full confirmation of diagnosis, eg, thrombectomy or pericardial aspiration for penetrating chest injuries and loss of signs of life

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Work-up

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  • • Physical exam/trauma work-up

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Treatment and Management

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Surgery

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Indications
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  • • See section on particular etiology

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Treatment Monitoring

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  • • Blood pressure

    • ECG

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Prognosis

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  • • Varies with etiology and severity

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Resources

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References

American College of Surgeons: ATLS: Advanced Trauma Life Support Student Manual. American College of Surgeons, 2004.

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Essential Features

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  • • Most common cardiac neoplasm is a metastatic lesion (carcinoma of lung or breast, sarcoma, melanoma)

    • 75% of primary cardiac neoplasms are benign (myxoma, rhabdomyoma)

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Myxoma

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  • • 75% of benign primary cardiac tumors

    • Appearance ranges from smooth, round, firm encapsulated mass to loose conglomeration of gelatinous material

    • Most attached to fossa ovalis of left atrial septum; some may occur in right atrium or ventricles

    • Histologically, contains various mesenchymal cells

    • –Abnormal DNA ploidy may correlate with recurrence

    • Papillary fronds attached to aortic valve associated with cerebral and coronary embolization

    • Fibromas occur in pediatric patients, slowly invading conduction system

    • –Can cause sudden death from arrhythmias

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Epidemiology

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  • • Primary tumors of heart are rare

    • –0.002–0.3% of autopsies

    • Occur in any age

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Clinical Findings

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Symptoms and Signs

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  • • Presentation depends on type and location of tumor

    Malignant tumors: Rapidly progressive congestive heart failure from valvular or myocardial infiltration

    Myxoma: Fever, weight loss, anemia, systemic embolization

    • Mitral stenosis can occur from tumor causing characteristic early diastolic sound "tumor plop"

    • Fibromas can cause sudden death from arrhythmias

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Laboratory Findings

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  • Myxoma: Abnormal ESR, ...

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