Cardiac Tamponade

What is cardiac tamponade?Type of pericardial effusion in which blood(most common), fluid, pus, clots, or gas accumulates in the pericardial space, resulting in compression of the heart and decreased cardiac output as a result.

Pericardium typically has 20-50ml of fluid.If fluid increases slowly, pericardial sac can expand up to contain a litre or more, but if fluid effusion occurs rapidly as little as 100ml can cause tamponade.

Causes: Aortic aneurysm heart attack, Post heart surgery(chest tubes used for drainage are

prone to clot formation and blood that should be drained accumulates around the heart)

penetrating and blunt wounds (chest trauma) Cancer hypothyroidism Uremia idiopathic pericarditis infectious disease(viral or bacterial) anticoagulation, connective tissue diseases(SLE and rheumatoid

arthritis). Dressler's syndrome can occur as a result of any type of pericarditis. iatrogenic

Beck’s triad

DISTENDED NECK VEINS

MUFFLED HEART SOUNDSHYPOTENSION

OTHER IMPORTANT SYMPTOMS:AnxietyDyspneaTachycardia tachypnea

pulsus paradoxus: decrease in systemic blood pressure by 10-12mmhg during inspiration and can be accompanied by increase in jugular venous pressure (kussmaul’s sign).

maybe cyanosiscold and clammy extremities from hypoperfusion.

musculoskeletal painFeverdysphoria

orestless body movements

ounusual facial expressions,

orestlessness,oforced position: sitting or leaning forward.

Complications:Heart failurePulmonary edemaShockdeath

Differential diagnosis:

aortic dissection,pulmonary embolismTension pneumothorax

pleural effusion

Diagnosis:chest x-ray: cardiomegaly, water bottle shaped heart, pericardial calcifications, evidence of trauma. MRI, ECG

Echocardiogram:

Treatment:Oxygenvolume expansion with blood,

plasma, or isotonic sodium chloride solution, as necessary, to maintain adequate intravascular volume

Bed rest with leg elevation - This may help increase venous return

Inotropic drugs (e.g., dobutamine) removal of pericardial fluid by

pericardiocentesis or pericardiotomy

Epidemiology: more in males than in females tamponade related to trauma or HIV is more

common in young adults. tamponade due to malignancy or chronic renal

failure is more common in elderly individuals. Mortality rate: 4% Complication rate: 17% mortality rate depends on the speed of diag-

nosis and treatment if untreated the condition is rapidly and uni-

versally fatal

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