Cardiac tamponade

[luxor]

A note says "free wall rupture causes cardiac tamponade because the pressure increases in the pericadial cavitity" Why does the pressure increase in it?
I think there should be no presure in the prericardial cavity because it should be also ruptured.

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[differentiating]

Why would the pericardium be ruptured?

 

[sloop]

Agreed, there's no reason to think that the pericardium would rupture as a result of an MI. With the caveat that this is definitely not my specialty, it seems like the major blood supply to the pericardium is via the pericardiophrenic artery, a branch of the internal thoracic artery. Coronary arteries have a minor contribution, if at all.

 

[luxor]

Why would the pericardium be ruptured?

Because it has a hole through out pericardium as shown at the image.

 

[Rekt]

Because it has a hole through out pericardium as shown at the image.

For demonstration.

Free wall rupture does not cause pericardial rupture so you wouldn't have intrathoracic free fluid. The fluid will be contained within the pericardium causing near immediate tamponade. Tamponade is all about the rate of fluid accumulation and not amount.

 

[Epilepsy365]

Pericardium is another sac that's not shown in the picture. You need to open your anatomy book and think of these vocabularies in layers. Honestly, the concept isn't hard. It's the thought that the pericardium is another sac that escapes people mind and makes cardiology complicated.

 

[differentiating]

Because it has a hole through out pericardium as shown at the image.

No, the hole is in the ventricular free wall. As said above, the pericardium is a sac surrounding the heart, and is not involved.

 

[jdh71]

Yeah but what if the pericardium then pops like a balloon. That would be the end of the tamponade and solve all the problems.

 

[luxor]

No, the hole is in the ventricular free wall. As said above, the pericardium is a sac surrounding the heart, and is not involved.

Thank you...it is "in" the ventricular free wall. Thank you so much

 

[luxor]

Yeah but what if the pericardium then pops like a balloon. That would be the end of the tamponade and solve all the problems.

Thank you so much.

 

[luxor]

Pericardium is another sac that's not shown in the picture. You need to open your anatomy book and think of these vocabularies in layers. Honestly, the concept isn't hard. It's the thought that the pericardium is another sac that escapes people mind and makes cardiology complicated.

Thank you so much!

 

[luxor]

For demonstration.

Free wall rupture does not cause pericardial rupture so you wouldn't have intrathoracic free fluid. The fluid will be contained within the pericardium causing near immediate tamponade. Tamponade is all about the rate of fluid accumulation and not amount.

Thank you so much!

 

[luxor]

Agreed, there's no reason to think that the pericardium would rupture as a result of an MI. With the caveat that this is definitely not my specialty, it seems like the major blood supply to the pericardium is via the pericardiophrenic artery, a branch of the internal thoracic artery. Coronary arteries have a minor contribution, if at all.

Thank you so much

 

[jdh71]

Thank you so much.

Ok. Yes. I’m having some fun at your confusion. I can’t say I was never confused as a student. Or a resident. Or a fellow. Or even as an attending. The things you get confused about change of course. Keep up the good fight. It does get better.

 

[CherryRedDracul]

Yeah but what if the pericardium then pops like a balloon. That would be the end of the tamponade and solve all the problems.

Some people pop it on purpose.

 

[Frazier]

OP: I've never heard of the pericardium rupturing from blown out myocardium.
The pericardium is pretty tough, it takes a good bit of force to rip it by hand.
You can get tamponade from penetrating trauma, which might be difficult to aspirate if the pooling clots.
Patient crashes, then time to open the chest.

OP:

Pericardial Window

A pericardial window is a procedure in which a small part of the sac around the heart is surgically removed to drain excess fluid.

www.hopkinsmedicine.org

 

[jdh71]

Some people pop it on purpose.

the surgeons tell me pericardial windows always seal back up after some time

 

[Moko]

Patient crashes, then time to open the chest.

Seems a bit aggressive coming from a hospice and palliative care doc.

 

[Frazier]

Seems a bit aggressive coming from a hospice and palliative care doc.

hehe touche